DwayneEMTP

How so?

Yeah man, if you're a medic and a manager with the type of presentation that you've given here I would bump your trucks back to BLS. I truly have no idea what half of this means. I'm hoping that the parts that I can almost understand have been misinterpreted by be, as it sounds as if you're off in the ditch on most of what you mention. I would love a clarification. Dwayne

I do think that you may give yourself a little trouble by being so committed to arrests. They are dead, and in the very best systems in the world the odds are excellent that they are going to stay dead. I don't get emotionally involved in arrests really as they are truly the dumbest calls we run. They are as close to cookbook medicine as one can possibly get. There is nothing that I can do to comfort this pt, nor to hurt them, very few s/s to investigate, my index of suspicion for them being dead is very high. Just pretty much the only time that we're going to shotgun medicine. It's hard to know for sure if you did everything that you could have done when you only really explained that you did compressions and delivered some shocks. I'm sorry, I can't remember if you're BLS or ALS so I'm not being critical, I'm just not sure what you should have done within your scope. But I can tell you this, if you did good quality compressions and delivered shocks on a shockable rhythm, then you did do 100% of the things scientifically proved to make any difference at all in decreasing mortality/morbidity. For me, these calls are all about the families. I truly love caring for the family members after a tragedy like this. I'm not sure why, but I do. It did make me a little batshit at first that I got at least temporary ROSC on nearly half of the arrests that I chose to work and yet still didn't have any saves!! I mean, c'mon! If the heartbeat came back for 10 minutes then surely the friggin thing could keep going long enough to get them out of the hospital and give me bragging rights!! Yeah, not so much. I'm not sure how many arrests I've worked, but there have been a bunch, and no saves. The EMS Gods don't seem to care one little bit about how I feel on these issues. Someone said that it's ok to think of this call 24/7, but I disagree. I can see 24 maybe, but if it's been more than just a few days I think that maybe you need to talk to someone that can guide you. Interrupted sleep is certainly a sign of an emotional bruise, but certainly not the only sign. I'm guessing that you did fine. As you do more of these I believe that you'll come to find that being as emotionless as possible is a plus on arrests. Arrests aren't so much about good medicine as they are about making sure that you push all of the correct buttons near the correct times. Keep your chin up brother! Dwayne

I would love to see that strip. I'm curious how she began a regular rhythm at such a slow rate when it appears that the AV node is firing around 70+? Unless it's a ventricular rate of course, but didn't you say that she converted to a sinus rhythm? Hmmm...will have to read back. And Crotchity, every friggin' time I try and be convinced that you're more than just a pain in the ass you say something like, "10 cardiologists, 10 answers..moot"...what bullshit! This isn't about pt care any more, this is about education. You aren't interested as no blacks are being abused in this thread, so you can leave it alone, but why are you so motivated to be negative? I can't figure you out man... Dwayne I disagree with the third degree brother because a third degree is disassociation, yet in this case we have the absence of muscle activity in both hemispheres, right? If a third degree then we should have atrial involvement with each electrical impulse, yet we don't. I do agree that the rare beat that we do get is likely a ventricular escape beat. Anyway, cardiology is not my strongest suit, in fact it's near the bottom, with all of my other suites..grin. No disrespect intended to your opinion of course. Dwayne

Man, I'm going out into left field and going to take a guess at hypocalcemia. What shot me off in that direction is that I thought that maybe there was a hind of a J wave in the 3rd strip. Also, it appears to me that there is electrical activity at a rate of about 74-76bpm but that the muscle is only responding on about every 6th beat, which leads me to believe that though there might be an electrical element here I would be more prone to believe that it's electrolytes or toxicologic. I can't intelligently defend this stance as its more of a feeling, or intuition that the result of a logical path, but I do have a feeling that I'm somewhere in the neighborhood. Electrolytes feel right though only because I can't think of many other reasons for the heart not to be responding to the delivered impulses regularly. Having said that, I don't know what other symptoms might accompany hypocalcemia, nor what I would do emergently to treat it, nor what may have caused it (My brain keeps showing me toothpaste, but I have no idea what that might be about.). I've never wanted to google an answer so bad before posting in my entire friggin' life as I know I'm missing something obvious and am going to end up looking like a bigger dumbass than usual. So my treatment here would be O2, apply pacing/defib/3lead pads, IV, Atropine 0.5mg, and hope like hell that I don't get to the hospital to hear the doc say, "What? Are you a complete moron!?! This is obviously X!! All you had to do was Y!!" So there you have it. Awesome case..I look forward to further conversation. Dwayne Edited to adjust formating.

I fail to see where you believe that I've made or attempted to support a point. I have no dog in this fight nor do I have a valid perspective being neither political, gay, nor military. It was not my intent to shore up the anti gay/military point of view but to simply share an enectdote that I found interesting and possibly illuminating in a thread concerning the subject. Unless you believe that calling his argument valid meant taking his argument as my own? That was not my intention but to use the word 'valid' in it's more correct context when applied here, to mean that he presented an argument that I believed carried logical weight. Certainly not taken personally and had I presented this as my point of view as opposed to simply interjecting what I considered to be an interesting peripheral "Hmmmmm" then I would welcome a sound thrashing. Maybe your point is simply that my peripheral thoughts and ideas had no place in a fact based discussion? But is there significant data available on this subject to even pretend that it is being debated in a quantifiable arena? Perhaps there is, but if so, I've not seen any presented here. In fact I've not really seen anything more scientific some idiotic gay bashing from Shithead and a bunch of personall feelings and unsuported arguments stating a homosexuals effectiveness as a soldier. As always my comments are meant with respect. I'm not sure that I'm getting your point, but I'm trying. Dwayne

You know I had this argument about 10 years ago with a friend of mine that had served in Viet Nam. He had served several tours as the commander (?) of an artillery unit. He was vehemently opposed to gays in the military and I just couldn't understand this point of view coming from one of the most kind and compassionate men I've ever know. We truly argued about this for 24hrs straight with nothing more than pee and pizza breaks. He said that it didn't matter what the facts were in units that were to be placed squarely in harms way, that it only mattered what the perception was. He was confident that a soldier that admitted to being gay would have been killed by his comrades during combat situations. He claimed that during those times of extreme stress, even worse when the stress would continue for weeks or months at a time, that superstitions, urban legend and just plain 'gut feelings' begin to reign supreme as men look for hope and reasons to believe in their indestructibleness despite the ever present evidence to the contrary. He believed that then, and he believes that the feeling is just as valid today, that those perceptions would harm a units ability to perform and survive. Having never been military it's certainly not my place to invalidate his argument. For the record, I have worked around gay men and women much of my adult life. I've slept in the same rooms, showered in the same rooms when necessary, and have no issues with them in any way. But I did come to believe that my friend had a very valid point. Unfair? Absolutely. But what do we do when unfair comes face to face with reality and mortality? I have no idea. I want to live in a world where everyone is allowed to rise to the hight of their desires and abilities. But hoping it is so doesn't make it so. Dwayne

Where has this happened? You've simply taken the one poster which everyone in the thread disagrees with and used him as the standard of care for our system. Ridiculous. If that was the case then I wouldn't really have any idea what you're looking at or refusing to defend, now would I? It's not that you refuse to defend it, it's that you seem unable, in too manyof your posts, to comment on it without the, "Oh, poor children" tone and yet consistently show yourself to perform at an intellectual/logical level well below that of many that are created in the system that you lament. I'm not ashamed of my system, nor my education but you're hypocrisy gets tiring. No, not in my view. He used it to show how far out of date the posters thinking is. You would have used it, while shedding a tear for us poor ignorant souls, as a benchmark to try and show that your system is 20 years ahead of ours. Maybe it is, but you're not a good example of that superiority. It just seems to me that if you're going to consistently crow about your systems superiority then you should make some effort to show that you are actually worthy of working in it. Awesome example. I truly have no idea what the above sentence was mean to communicate. You may have to dumn it down for me. Why is it so difficult for you to understand that it's not fascism? It's simple, intelligent, professional adult presentation? In our medically 3rd world country our basics manage it, our paramedics manage it, our docs and nurses seem to be excellent at it, why is it that you find it so overwhelming? And what part of this being an educational forum don't you get? We learn, we teach, we set an example for those that come after us. Easy right? I can't imagine how a 4th grade presentation fulfills any of those things. Simple really. Dwayne

You know Zippy, its almost time to put you into the troll catergorgy I think. I'm getting curious to see if you're even able to create a post that doesn't simply boast on your country or insult ours. Always with infantile spelling, grammar and capitalization of course. (Edit:: of course after creating this post I discovered that you actually had created a few posts that did more than brag, so my apologies for the above comment. Not removed as others might have already replied to it, though of course the presentation remained childish. I'm not clear how you feel comfortable being so cocky about your system when it appears that those in your system are unable to create written communications at the adult level?) Yikes brother. You are terribly behind the times. Transport a traumatic arrest? No man, not for any reason that I can think of, in fact I can't even think of any special circumstances that would cause me to work them, much less transport them. And I'm not playing coroner, I'm following standard of care in my area that is following science based medicine. Run with arrests, good CPR in a moving ambulance, giving the family hope that everything that could be done has been done, all of those concepts are archaic. Of course Zippy actually discovered them all and his country had been following his example for 30 years...just sayin'. You need to try and stop being so judgmental and angry and take this opportunity to discover that you have a lot to catch up on and be happy that you have a bunch of people here that would be more than happy to help you do so. Dwayne

You need to get that documented with backup from your coworkers. Then when you get injured you and your lawyer can own yourself a brand new ambulance company and fire the idiots that take such a moronic stance... But as Mobey said, you need priorities. If you don't have a mate and kids yet, perhaps your priorities are unclear for you at this point. When you do, you'll find it much easier to tell these folks to go and piss up a rope. And I don't think anyone is suggesting that they would refuse these patients, just that they would find a way to resolve the situation that doesn't include risking their safety. You truly must, must, must get good with the fact that if you work rural and you have an altered pt capable of injuring you that you have to wait for additional support. While you're waiting should s/he further injure themselves? I'm sorry for that, but they are not going to injure me. That has absolutely got to be your drop dead, no compromise, 'aint even interested in talking about it point of view going into each call. Other points of view lead to pain and sadness. Dwayne Edited to syntax. No significant contextual changes made.

But see, I don't see where she was promised 5 mil, she just seems to be assuming that it will go that high! And you're still a vigin at heart babe, just a virgin with skills... and that should be way more valuable in my opinion.. Dwayne

Yeah brother, maybe you just pulled the drunk out of the air, but as said by my betters, you really shouldn't be screwing with that guy when he is that lucid. But if you must, the correct treatment sequence would be, tazer, IN Versed (or whatever), more IN Versed, then an IV if you feel there is still a need. Now I, as well as a few others here I'm guessing, am not going to pretend that I've not crawled into the back of the truck with a mean drunk on occasion when I'm feeling a little bit froggy. I'm also not going to admit that I have. But if I had that would be very unprofessional, dangerous to myself and my family's financial security, open myself up to a multitude of moral/ethical/legal issues and set a very bad example for anyone stupid enough to do such a thing when other, more responsible options exist. And it was likely so that I could give him a shot of IN Versed. If it happened at all. Which it probably didn't. Just sayin'.. And, in case you didn't pull this guy out of the air, why WERE you dinking around with a 200lb drunk that had himself barricaded inside of his car? Suicide or some such? Either way, still a cop issue, I'm just curious. Dwayne Edited to correct a spelling error. No other changes.

Yeah Ugly, as I read your post I find myself calling bullshit on myself here. I've slung the term hypocrite around plenty, but perhaps I have to wear it this time... Not long ago I was in a thread just friggin' beside myself not understanding why people can't understand that I'm anti death penalty. It seems so obvious to me that we can not allow one single innocent person to suffer simply to make sure that ALL of the bad guys suffer. Some bad guys have to walk if we're going to protect the rights of the innocent. Yet in this thread I was having trouble with the concept that to make sure that all deserving get cared for then we simply have to accept that a gazillion assnapkins are going to hit the lottery. It makes me sick, but you're right, it is the right thing to do. It would be nice if the money could be spent intelligently, but we have a ton of docs that are willing to lie matched with a ton of public employees that are willing to limp and cough on cue. We'll just have to hope that there is something left for those that actually deserve to be loved and cared for. Thanks for hanging in there Ugly...I knew if I waited long enough, kept reading, someone would make up my mind for me... :-) Dwayne

What do you think? (Video not verified genuine, but I believe it to be so.) For the liberals, her body, her choice? For the conservatives, prostitution? Girls are giving it away every day, any reason they shouldn't sell their cherries?

What a beautiful young woman.... Thoughts of peace and healing for her family and all who loved her from the Womacks in Colorado. Dwayne

The only thing that could have made this joke better was to have posted it before Happiness!! :-) Great joke though anyway... Dwayne

Hey Dawg, welcome to the City! I just responded to one of your posts in the '911' thread. Good post, I liked it a lot. Dwayne

Hey Adrian! Welcome to the City! Are you working as a medic now? Where are you from? Just like EMS, the City is not a spectator sport. Jump right in, get dirty, be brave, help, be helped. You'll find a lot of value here I believe. I look forward to your thoughts brother.. Dwayne

Ugly, Dawg, points taken. That is why I decided to chew on this for a bit before deciding how I feel..And Yet I'm still not sure. Though Dawg, I'm not sure why you say that the tone is uncalled for? That is how he feels about the subject, why should his tone not reflect that? (Below please read 'fire' to mean the majority of the fire services/larger fire unions. I know that there are true 'smoke eaters' out there and have nothing but respect for them. Also I know that there are many that do the job for love of their community, I just happen to believe that 90% of those that claim to are either bullshitting themselves or trying to bullshit me. I love many firemen, some of my best friends are current or previous firemen, I simply have no respect for the fire services. Just wanted to try and be clear about that before the following comments got a bunch of hero worshipers crying.) I'm sick to death of most of the bullshit that comes out of the fire services. Well paid, good bennies, but on almost any given day you can find a story of someone trying to do less, cheat, steal, lie, and get more. And yet, they still have no problem taking a bow any time someone uses the word 'hero' within their hearing. Of course I'm generalizing, but unfortunately for the fire services, these dirtbags are becoming more and more visible and are going to begin hurting fires hero image with the public I think. I want no one to suffer. But I've worked the oil spill in LA for the last 4 months and see what happens when there is a big pile of money and people start fighting for their 'victim' status. Those of us that spent some time overseas in support of our military have been exposed to all sorts of nasty shit from TB to all of the toxic leftovers from generations of bombings yet ask no special treatment, as that is the gig we signed on for. I just have a bad taste in my mouth when I watch people strut around saying, "I do this to serve. I put my life on the line every day for you!" (Bullshit) But then when something bad happens many immediately go to, "Holy shit!! Did you see that!! I almost got killed! Somebody should pay me something! I shouldn't have to work any more because that gave me bad dreams!" We speak of the younger generation of kids and their sense of entitlement, though I don't think that I've ever seen such a sense of entitlement as that that comes from the fire services. I think others, as the man in the editorial, see it as well, and are also fed up with it. I want everyone to get what they fairly deserve. I guess where I have trouble with fire is that they have been getting so much more than they deserve for so long, been basking in the glory of the "Someday you'll see why they call me a hero!" that it's hard for me to drum up sympathy now that they've actually had the 'oh shit' moment they are so famous for crowing about and find that being a hero sometimes comes with risks. They want to be heros, but don't want to accept risks. How does that work exactly? I'm truly on the fence, and that's not a usual state of affairs for me. I'll have to wait until my betters talk about it a bit and see if I can find a place to land from your comments. And Ugly, I don't see any way that they could have listed the majority of these people with preexisting conditions unless they tried to get insurance after the incident. And that's just not how insurance works. Have a great day all... Dwayne Edited to add the text in parentheses.

What are these folks asking for that has got this guy so shook up? Are Fire and PD asking for big settlements? I don't believe his issue is with unemployment. And lets be honest and admit that many of us are tired of watching the disabled firemen at their bowling or softball tournaments because they were gifted with an unusual ache or pain that got them sidelined from employment but able to go full steam in life. I'm holding off on being too vocal until I have some idea what it is that they are looking for. Dwayne

Welcome back man! And thank you for your military service. Not much has changed in a while, we've lost some awesome members, gained a bunch of new awesome members, still have a few chuckleheads floating around, but all in all it's still the same valuable resource now that it was then. Jump in with both feet! Dwayne

Man, as if chemistry is hard enough already!! Pretty interesting to see things changing after all this time...I wonder what the next 100 years will bring? Dwayne

Man, I wish that I could give this post more than one point. It's awesome! +5 in spirit. Great post Ugly. I learn from you every time you post brother, you're more my teacher than me yours. Man, there have been a ton of great threads on the City lately!! Thanks to all for participating! Dwayne

Welcome to the City Jason! It sounds as if you've had quite a time.. Thanks for the intro! Dwayne