DwayneEMTP

Man...couldn't get Annie, Happiness or Wendy in on this? I thought they'd be a shoe in for innuendo insanity!! (Ever notice the irony in 'innuendo' also being an innuendo?) Dwayne

Point well taken Happiness, and appreciated! I think perhaps the context of my reference for Etenox is getting lost. I'm not claiming in any way that it is a bad drug, not that the use of it when ONLY the effects of the drug are considered should be limited to ALS providers. My point was in reference to BLS providers using it and my concern that at that level of care that a change in mentation can be a relatively early and obvious sign of a change in overall pt status, and that masking that sign for many BLS providers may not be Do No Harm medicine. See? I believe that many ALS providers as well as a bunch of BLS providers may pick up significant changes in patient status outside of serial vitals with a change in color, or coordination of limbs or face, or eyes not really tracking as well as they were a few minutes ago, but many, many won't. And often, in my limited experience, a change in mentation will precede even these signs so I'm wondering at the wisdom of removing a relatively obvious symptom for providers not necessarily educated to the value of the others. If that makes sense. (Posting while also visiting with my boss, so I'll ask you to forgive a lack of continuity.) It seems that when we discuss these issues we often look at them from the point of view of an isolated injury, though in my experience, that is very often not the case. To remove vital information from a multi-system issue when addl skills for monitoring those systems may be weak seems as though it may not be prudent. And I would certainly consider a change in mentation to inappropriately happy, or inappropriately sad to be and issue. See? Thanks for your thoughts! Dwayne

Chicken! As House would say, "Bros before ho's" I mean, she just plastic after all... Well, at leas outside of many imaginations.... Dwayne

Agreed. But very few in the prehospital environment. At least very few classes. It was my belief that this discussion was centered on a person's rationale for managing pain, or not, and how aggressively they may choose to do so, why, and at what level. You must be speaking above me man..I have no idea what any of this means, or the context intended. And I'm calm as a gentle breeze brother, and yet still completely disagree with your statements and your presentation. This is a professional forum. You, as with all of the other 'I just came to hang out, not to be judged' crowd either are already or will become invisible as we have many, many intelligent providers here that don't believe that you have to present yourself like a child in order to be informal. You like to consider yourself an EMTCity intellectual, and as such you should feel obligated to set an example for those that come after you. Instead you choose to spout a bunch of almost intelligent sounding stuff hoping that the kids here will be amazed and the rest will be too scared or too lazy to intervene. Up to this point I've been too lazy, but I'm wide awake now and ready to play!! So if you continue to champion your 'grammar fascism' bullshit, it's going to be a long day man.... Again, I seem to have lost your context. I'm probably so focused on your grammar that I can't follow the complex logic. So you have seen Entonox at therapeutic levels that caused no change in mentation? Really? Has this been anyone else's experience? And if you believe that giving them the option to self medicate and then removing it to check mentation every 5-10 mins and then giving it back is the same as monitoring mentation status, then you have no real idea what I'm talking about. And I could care less if it's self limiting or not, as that has never had a single thing to do with the questions that I've asked you. Again, you seem to think that if you keep saying the same things over and over that we're going to confuse that with continued, intelligent debate. Not happening for me, and I'm going to guess that others aren't fooled either. As above..this snippet of lecture was tied in with what point, and in what context?? Dwayne

Ouch...Like a moron I only breezed through the article not paying attention to such silly details as who, and where. Point taken, and my apologies to anyone that may have been offended by my laziness. I was calling out CSAR as he and I just a few weeks ago were discussing that Boston EMS is known, to the best of my knowledge, to be one of the top systems in the country. I will pay better attention in the future. Thanks for the reminder not to be a 'band wagon' shithead Mike... Dwayne

I'm with you man..I'm one of the freaks that actually looks forward to my recerts. I learn or relearn something every time, and in each group of chucklehads there's at least a couple of other medics that seem to have my same stellar attitude that are interested in debate and asst bullshittery. It really isn't a hard standard to uphold. I would be curious to see how many of those were firefighters, but I have no idea how that system works so it might not be a fair comparison. Dwayne

A few points... First, I'm uncertain why you quoted TJZ and then failed to address any part of his quoted text, at least that I can see. Second, why is it when providers from other countries criticize American prehospital training/education they often do so with 4th grade grammar, punctuation and capitalization? And lastly, did you find my questions on retarded mentation in pain managed patients to be below the level of this conversation or were just not interested in contrary points of view? Dwayne

Hey! Where in the hell is CSAR Medic! I want to see your certification young man!! We were just bragging on how awesome Boston EMS is the other day...What the hell is going on up there? Friggin' mouthbreathers... Dwayne

Do you not consider mentation in the medical and/or trauma pt to be an important physiological marker then? I've often been warned early on that a pts status was changing base on the fact that they've begun to get anxious where they were not before, or the reverse, or have become suddenly or slowly quiet, have begun using nonsensical words or slurring their speech. Does this drug not mask those symptoms or is it your contention then that they are still just as reliable only subdued? It's long been understood that proper pain management often changes the level of pain but not the location or quality, but physical pain is not our only concern when deciding who, when and why analgesics should be employed. Traumatic scenarios are not the only that should be considered when deciding who should be allowed to to deliver these interventions. Comorbidities must also be considered, and that type of anatomical/physiological understanding will not be obtained in a weekend class in my opinion. Narcotics can absolutely help to overcome guarding in a patient that is in pain. But unless you have some idea what that assessment is for, and what benefit you can provide for having discovered it, then the Basic argument is the same, as well as it should be for medics in this case. Dwayne

Alright....if you're sure you want to see some hairy Italian looking guy sucking on my boobs... Try this one... http://exitoina.com/silvina-escudero-y-el-stripdance-mas-caliente/

Stumbled onto this this morning and thought, "Hey! We have some very creative people at the City, maybe they would like to do this!" The 'shave your beaver' game So, the deal is this, you shave, wax and/or dye your beaver in the most creative way possible, and then show it to all of your friends! Awesome concept, right? Now, don't be nervous. I know that some of you probably have a shaved beaver hidden away somewhere that you've been hesitant to show, afraid that perhaps your beaver isn't as creative, or stylish, or looking as young and hip as some others. Others may have already shown their beavers to the world but feel a need to start fresh and then show them only to their friends at the City. Either way, here is your chance to shine. And the best part? If you've made some mistakes, perhaps gone overboard and done things to your beaver that you wish you could take back? Just click, 'reset' and you'll have a brand spanking new beaver to play with! Ahhh...it's a great time to be alive! So, don't be afraid to play with it, take your time, poke and prod until you've gotten it Juuussst right, and when you're convinced that you have the hottest beaver at the City, post the link here and we'll be happy to take a look and give you our opinion! Just follow the link above, go to the 'games' tab, and click on the shaver your beaver button. The rest is rudimentary. See you in the pond! Dwayne

I can see paramedic response backed up by a dual basic truck, but how do you justify it the other way around? It just makes no sense to me to have a basic assessment decide if a medic assessment is necessary.. Dwayne

http://www.youtube.com/watch?v=t41NlNd1sEE

Awesome post Bieber! Well thought out, honest, introspective, with great explanations for your logic...Really, really good post. I've read this type of statement a few times during this thread. What kind of protocols do you mean? Other than, "A provider should give serious thought before delivering narcs to a hemodynamically unstable pt" or the like, I can't think of a pain protocol that I've worked under. I had medics at my last service claim that we were not to give narcs for abd pain, but I did, and do, and afterwards tried to find their reference, but couldn't do so. Now, understand, I have never memorized my protocols word for word but always have a good 'flavor' of what each might entail and I can't really think of a protocol that a pain patient my fall within other than those listed as indications for the drug? If they are in pain and I can mitigate that without retarding their condition then I do so... I am so with you here. As in Crotchity's example, (and humor taken in the spirit intended as I wouldn't have been able to pass that up either) I would almost certainly not have given that pt narcotics as his physiological markers were calling bullshit on his verbal claims. Yeah man, I wish I could give you several ++++s plus a gold star for this statement. Me too brother.. Agreed completely. One of the reasons that many basics have a hard time understanding this is that their clinical/physiological knowledge is to shallow to be able to understand the explanations. It's difficult to explain when you can't explain that a fracture, is not a fracture, is not a fracture. It's the same mentality that says that " I don't need to know how the heart works to put on a splint!" But, well, it really helps to know how circulation works if you're going to apply a splint to a complicated fracture while trying to allow the greatest possible long term outcome. I think you've made your point perfectly, I'm just piggy backing it so that I can steal some of your glory.. I do wonder about folks saying that Nitrous should be allowed for basics based on the fact that is a relatively safe drug and self administered. I've never used it, but I can accept that it's relatively safe, the problem I have is that it may mask sysmptoms, mental/physiological that should be caught throughout an ongoing assessment. Many medics I know can't manage that on unaltered patients, I'm not sure I'm comfortable with that at the basic level. But again, I'm speaking from ignorance as I've not used it in my practice. I am curious to see what others think... Have a great day all... Dwayne Edited for formatting, again. No contextual changes made. Say Admin, how many years must I be here, or how many posts are required, or what minimum Rep rating do I need before I can get an actual response to my issues over the editor and limits on numbers of quotes??

I believe that pain management is one of our most important tools, and one that is very much under used. And of course I don't believe that basics should have access to narcs/benzos. One of the things that makes me batshit crazy is to listen to the yahoos talk about how they're able to 'spot a drug seeker' a mile away. Bullshit. I've even heard them talk about withholding pain management for their drug seekers that they truly believe are now in pain, based on the patients previous history. Man, this is one of the best reasons to increase educational standards for EMS. Perhaps is those folks have their knowledge to be proud of then they won't need to attempt to show their 'specialness' by showing how callus they are because of all of their 'experience. I believe that my job is to provide physical, physiological, and emotional support when possible. And though I don't often share their beliefs I certainly find no need to interfere with their spiritual beliefs either and am happy to find such support for them when I can. Have I given narcotics to a known drug seeker? Probably, but often I haven't, not because I believed them to be seekers, but because the list of symptoms that they chose to give me to fulfill their needs lead me to believe that narcotics weren't prudent until after a physician level exam. Ladies and gentlemen!! Drug seeking is a symptom! Because you happen to believe that these people should not have interupted your tv show with their silly symptom doesn't mean that they deserve less professional care! Thank you for listening. To our newer and younger providers. You will be awash in shitheads that are going to try and convince you that you haven't made your bones until you have proved that you are tough enough and experienced enough to deny proper care to those that you don't feel deserve it. Sounds crazy, I know, but most here I believe will back me up on that. Should you choose to join that club I'd ask this simple thing. Turn over the card that your certification came printed on, and in a Sharpy marker write, "This certification no longer applies to me. I have decided to become one of the wanker shitheads. I have earned the right to wear the patch, and my hero Tshirts, but I have forfeited my right to consider myself a professional medical provider." And then go on with your life. Every patient has a right to have an ambulance come to them. Every patient has a right to a professional, thorough assessment, and every patient has a right to complete and competent treatment based on that assessment up to and including emotional support and pain management. Ok? As often happens you may think that I'm on the fence on this issue...I'll try and be more clear in the future... Dwayne Edited to repair formating.

Hey Colin, welcome to the City! A word of advice. In a forum you and you intelligence will be judged by your textual presentation, so spelling, grammar, punctuation and capitalization are important if you want to be taken seriously. Not trying to bust your balls man, just trying to give you a heads up. Enduro bike racing is pretty hardcore man! Running full time must have taken some serious training and commitment, good on you.... Jump in, ask questions, answer them when you can, but participation is the key to learning here... See you around the forums... Dwayne

LOL...thanks for that UE..And I would normally, but this is Dr. B, since the day I thought about becoming an EMT is he's been telling me what to do in one form or another, so I simply did it!! I just followed my conditioning! I'm so embarassed... Good advice though. Good video, 100% pass rate on boards? I don't know if that's good or not, but it sounds pretty friggin' awesome! Have a great day all... Dwayne

Done Doc, and will do so daily as long as the voting continues... What are we voting for, exactly? :-) Dwayne

Thought from the Greatest Living Scottish Thinker. Billy Connolly - "If women are so bloody perfect at multitasking, how come they can't have a headache and sex at the same time?" That is awesome!!! And not only do I love Billy Connolly, but he of course is the ultimate sayer of truths.... Dwayne

Man Tniuqus, that was an awesome story! Very few things piss me off as much as people spreading heroic drivel as fact, so I'm grateful also for the Snopes link. It's just good work all the way around. Thanks for sharing. Dwayne

Well, I hadn't exactly syncronized my watch, I was much more focused on my .... err... apology then the time, so it is an estimate. I'd forgotten about that picture! Hell, if I'd know I looked so hot I would have posted it myself! Dwayne

Actually I thought it was a pretty good list, and I've been doing this a few days now... And you can bet your ass that that list was created by someone that's been around, whether or not it was posted by a noob. Numbers 20 and 21 need to come off, as not only aren't they really funny, they are completely inaccurate in my experience... And #27? Mehhhh.... Dwayne

What!?! How correct were they!! C'mon Richard..I know you looked! Give! Dwayne