DwayneEMTP

Great idea! Great case! Great questions Moby.... But would a source of infection of that type create enough of a reaction to cause sepsis in that time frame do you think? Dwayne Edit. Why the Gravol?

Excellent choice. I don't think there was a 'bad' choice here.. Let us know how it goes? Dwayne

Note: These comments are created using my nearly complete ignorance of current events or the Koran, and therefore, of course, always subject to change given new, credible information. Before I even noticed, that thread it was 10+ pages I think, and unfortunately we've had very few productive, educational discussions that evolved so quickly so I stayed away. The reason I mention this is that I'll be giving my opinion without the benefit of those pages of discussion so if I'm repeating oft repeated thoughts and ideas, well, then I'm sorry about that. Just sayin'.. I've never really been in a position to forgive them, only, from my perspective, to choose not to hate them. They didn't attack me, they attacked America. Do I like that? Of course not, I love my country at least as much as the next guy. But to try and make it more personal then that is not only foolish, in my opinion, but poisonous. We've lost friends, neighbors and loved ones to this attack, I will not also poison my health and attitude. Of the event, I'm saddened. Of those that accomplished it? I have no more feeling than I would for a stray bullet that killed an innocent. I believe that it will effect me greatly. Once again we are attempting to choose an enemy that is not an enemy. The Muslim community in general is no more my enemy than is the Christian community in general. I am sickened by the knee jerk reaction surrounding this issue. I want to live, and have my son live in a country that refuses to punish people for something that they didn't do based on an affiliation that they were born into. Women are weak and ignorant, blacks have small brains and their build makes it obvious that they were created for manual labor and Muslims are terrorists or terrorist supporters. How many times do we have to prove these generalizations bullshit before we stop punishing people for our bullshit generalizations? I don't adhere to any religious doctrine, but many of my American brothers and sisters do, and as long as they profess to be American I want them treated as equals, based on their actions and judgements. If not, then why go to half measures? Why stop at slandering their character by restricting their access to ground zero, why not simply round them up and put them in camps until this whole mess is settled? What could possibly go wrong with that? I don't believe it changes the issue at all. We're sending the same message. That there are still classes of Americans. Some that are 'good' and others that, if not bad, are at least suspect. Some that are deserving, others that are not. People feel safer if they can identify an "enemy", something "we" can rally against. There has to be a "them" if there is going to be the safety of "us." That's simply ignorant, mob behavior. Prove that the Muslim religion in general endorses the shit that happened at the twin towers and I'll be onboard. Until then it's just a bunch of scared people looking for someone to hate. Dwayne

Hey Tniuqs, thanks for reposting that man... I'd forgotten about that document. If I'd been handed that during my clinicals they would have provided a completely different experience. I have nothing to add really, except to say that if you read that document and found that you disagreed with all or part of it then it's time to take your pulse as a preceptor, because that's friggin' gold there. Dwayne

I'm not sure what link you mean, but I've seen these adds since the very early years of the internet. (So yeah, the first four or five years that the internet was available I couldn't imagine a better use for it than viewing porn either!) Despite my best efforts I haven't sold a single 'scented' pair of my well worn Fruit of the Looms...I dont' get it... Dwayne Edit. Ooops. My new job as remote medic offshore at the oil spill gives me internet via carrier pigeon I think. After I'd posted the highlighted text finally appeared. Though it does nothing when I click on it, that again may be a speed issue. No other changes made beyond adding this message.

Great advice from all! Every basic partner I've had, specifically the new hires, get used to this saying... Q: "What's the first thing we do upon arrival at every call?" A: "Nothing!" Silly I know, but I've seen so often that people get worked up over the dispatched report, despite it very rarely having any resemblance to the actual call. (Not bagging dispatchers as I know that this is seldom their fault.) I do find that people new to the field, as I was not so long ago, tend to believe that thought can be replaced with motion. They often seem to feel that when they're confused that no one will notice as long as they just keep moving, whether the motion is productive or not. And trying to create so much motion when thinking, and not action, are what's called for, brings about an amazing amount of stress. At least it does for me. Ignore your dispatch report, unless it regards something you are unfamiliar with. For example, dispatched to "18 month female, difficulty breathing, lethargic." This often won't be the same call as it would be in an adult so you might want to mentally review the ways you may assess this pediatric emergency when compared to an adult. And when you show up to find the call is actually a 34 y/o that broke his leg trying to show his son a new trick on his skateboard you haven't really lost anything, but have gained a ped review. :-) Slow down, breath, don't do anything that you haven't decided is necessary. Don't allow yourself to freak out about thing that you have no information on. Sometimes gathering information will bring a bit of anxiety, but being anxious over what "might be" is hard on your body and terminal to your thinking. So when my partners say, "Nothing!" they don't literally mean nothing, they understand it to mean that they should stand still, take a deep breath, look around the scene to see who is where, who is doing what, and formulate a logical initial plan to approach. 'Nothing' refers only to their motion....stop the motion and you will be able to think more clearly, when you can think more clearly you will see and understand more, gather and analyze information more efficiently and you will make better plans, and once you can trust your initial plans, a great deal of the anxiety will resolve on it's own. See? Great question man! Thanks for participating! Dwayne Does that make you asexual?

Yeah, I'm thinking along those lines as well. Need a good set of lung sounds, but I have a feeling that fluid isn't going to be the issue. In fact I have a feeling other than some minor rhonchi, that the tidal volume will be good. (possible hint, but more possibly just crap) (Not trying to be a smartass without bothering to ask my own questions, but the others that are exploring this scenario have asked several intelligent questions that haven't been answered yet. I want to allow them the opportunity to ask follow up questions based on those answers without my questions moving the conversation off on a different track. See what I mean? I'm proud as hell that we finally have some BLS providers that are interested in ALS assessments and not just the drugs.) Just a guess though. But in case the stars have lined up and I'm accidently right I don't want to queer the conversation until others have had a chance to explore for a bit. Dwayne Edited to correct a spelling error and to add the text in italics. Second edit because I forgot to explain my first edit. No other changes made.

Not only are you certainly allowed to participate here, but good for you for doing so! I have a couple of pretty high confidence guesses, but lets play with it a bit before going down that road... Any complications during the procedure? What meds did the clinic recommend that the patient is non compliant with? Why was is he non compliant? Dwayne

You know Cutie, there are a handful of people here that make the City worth visiting... And you are one of those. You are smart, beautiful, sexy as hell. You're never afraid of a fight, always kind, always insightful...You're a gift to all of us. Thanks for all that you do. I can't wait to kick your ass next time... I love you Babe.. Dwayne

Completely non PC, but you want to know what really works? Panties...you're panties. No one will admit it, but if you doubt me, ask akflightmedic. I won't tell you what he recommended for me... "-) Cookies. DVDs of tv shows at home, COMPLETE WITH COMMERCIALS! I was shocked when Babs sent us tv shows from home to watch during our downtime and the guys begged for commercials. Pics of the kids, things that remind your man that you want, and need him naked, plus silly sweet stuff. I know this is going to sound perverted, and that's ok because honesty often does, but things that make him feel like a man, and a husband, and a father. That is what makes the time pass. Had I not had the advice of Ak and Dust when I first went overseas I would have run home crying like a menstruating 7 year old. It's stupid, and juvenile, but what gets men through is feeling like men. See? It's important that you remember that. Dwayne

Hey Mick, Welcome to the City! Bottom line here brother, 'specially after hearing the way that you represent yourself, is that you're a friggin' Marine! And the whole country loves the Marines. You're art will not hinder you a bit I believe, as you'll go into most interviews starting out on the top of the list because of your military service. Many things may hinder you getting hired, a terrible driving record, arrests secondary to poor character, etc, but the art won't even touch the fact that you've served your county. Covering tattoos is so common now that there are several skin colored options for covering sleeves. A new basic we hired has full sleeves yet I didn't have any idea for days, despite the fact that he wears short sleeved shirts. In fact I think, though I'm not sure, that even UnderArmour has a solution for it. Move forward brother to whatever it is you choose to do...you won't be hindered by such things if you choose not to be. Thank you for your service. Dwayne

Not required before my basic, but was before getting state cert. But it was required before getting into class for my medic. Dwayne

Yeah man, I see your point. I wasn't really thinking of it along those lines.... Thanks for your response. Dwayne

This, in my opinion, is forum moderation at it's finest. And I'm not being facetious. I think it's cool as hell that you allowed his post to stand but disallowed his ability to spam. Of course it pisses me off when you do such things to my posts...Just sayin'... "-) Dwayne

Though I agree with all that you've said, I think that your opinion doesn't cover the entire issue. The first place being that I'm not sure that women are a significant minority in EMS. I believe that it is as easy to get hired in EMS as a woman as a man, at least in most places, though of course I could be wrong. And I don't believe that your opinion addresses what I believe to be common misconceptions. First being that women, in general, are more compassionate and empathetic than men, in general. And women with kids more so than those without. And the second, and related to the first in this discussion I think, that those in EMS spend a large part of their time cutting people out of MVCs, looking for severed arms/legs, and doing other very gory and heroic crap. If you combine the two you have a population of women (overly empathetic) and blood and gore, (which intuitively appears to be much harder on this population than others), and you end up with an interesting topic I believe. Again I disagree. I believe that in most instances we are defined by gender, and I also believe that this is a good thing. We aren't the same, men and women. Many try and pretend that we are, but we're not. When I first met you I had preconceived standards based on the fact that you are a woman. If you had cussed like a sailor, farted in public, belched at the dinner table, I would have been very disappointed in you and we would not have the relationship that we do now. I expect a higher level of social function from you as that has been the majority of my experience in life. My partner, who I adore, says 'fuck' about every third word when we're in private, belches like a pig, though we've eliminated the farting issues...I expect that of a man, as men have enjoyed a different place in the social strata for his entire lifetime. Are these things important in EMS? Probably not so much, as I'd expect you both to do the right things when the shit hits the fan. I only point it out to attempt to disabuse the idea that society doesn't/shouldn't see a difference between the sexes. Agreed. But he doesn't seem to want to create a doc on EMS in general. He's interested in a subculture of the field. Assuming it's done well, though I know that that is an asinine assumption of course, aren't we all better for the exposure and perhaps working moms specifically? Isn't there the possibility that the exposure will give them the much needed clout to bring about political change? It's his camera, it's his format, shouldn't he be allowed to examine what he wants, in any way that he wants to? Would it be awesome to show EMS in a true light? Sometimes yes, most times, no. I work with a beautiful, sexy, competent woman medic. Her experiences and mine have very little in common. The fire dept wants to dote on her, lift for her, they compete for her attention on scene. She disallows this type of nonsense, yet it's still a hurdle that she has to jump over that I'll not likely ever encounter. That makes her experience different. Don't you also believe that people, upon seeing her, as opposed to me, have different expectations? I do. Would the study of those differences be interesting? Holy shit, I think it'd be amazing...but probably wouldn't sell much commercial time on TV. I can't disagree with you here, as I don't have the education to do so, but I can say that should my coworker be highlighted in such a way that I don't believe I would feel subordinate at all. I would be grateful that she and those like her would better understood because of the exposure. Here being special, strong, competent in some way doesn't make me less so. But again, if we're going to be realists, there are certainly plenty of men that would feel differently...so screw em'. A) agreed. Because no one cares unless is says 'Fire' on the side of the truck. His documentary isn't about helping EMS, it's about selling commercials. And no one is going to tune into a show about how things really work, at least I don't see it happening any time soon. I've probably mentioned way to many times that we don't play the news in the house because I don't know what happens to most of that ugliness when it goes into Dylan's head. So I believe that I get my news like the majority of the politically ignorant in our country...in sound bites. Condoleeza Rice? Isn't she the pubic hair on the soda chick that they used to try and torpedo a perfectly good Supreme Court justice? (Not my opinion, only my impression from the bits of news I've heard. See?) Married to a successful man, I think. Oprah is the bomb! I've watched her show. Never heard of her. I agree, but to believe that the abundant female role models have leveled the playing field, answered all of the questions that people have about those of you with weird girl parts, have convinced the masses that you are as good as men....I think that's still a bit unrealistic. But again, I could be seriously off in the ditch. Love back at you Cutie... Dwayne

Wait, there are chicks in EMS? When did that happen? The whole gigs bound to go to hell in a hand-basket now...I swear... Didn't sound like he was looking to make the promo video of EMS that you'd all like to see, but a video of woman and mothers. As much as I'd like to see something healthy for EMS we all know that this is going to end up being a documentary on women in the fire dept that also happen to work on an ambulance. Why? Because they'll welcome the publicity instead of acting like shitheads as soon as an idea is brought up. If the girls can get some exposure for what they do, and it's good exposure and not a bunch of yahoos running around like idiots before they run home to tend to their dirty kids, then I say go for it. Why does it matter that there are a bunch of single dads as well? That's not the show they're looking to make as I see it. Plus, I see tons more single women in EMS, and they have my friggin' respect, I'll tell you that. I'm not exactly sure how you care for kids, pay the bills, make it to little league, shop, argue with the ex husband, get almost no sleep what soever, and still come into work looking hot, and with a good attitude. I just really don't get that... Do single dads do as much? I would guess so, though I hope to never find out.... Nate, not the response you'd expected I'm guessing, though might be if you're familiar with EMS. It would have been significantly better had you responded to some of the questions, such as they were, instead of posting your request and then disappearing. Though I'm confident that many of the girls here likely gave you a call. I hope your project is centered on respect and recognition of the ladies that do this thing we do, I hope your intent is healthy for them and for EMS, and if so, I hope it flies. Dwayne

I'm sorry, I couldn't understand a word you said besides, "don'cha know?" And just out of curiosity, sincerely, what is the 'more?' Dwayne

I'll disagree with most here, though my experience may be different than theirs. EMS doesn't get boring unless you forget about the zebras. What does that mean? Most here know, as I've harped on it endlessly, but the quote that defines my silly EMS career is, "if you hear the sounds of hoofbeats, you're better served looking for horses than zebras." What this means, to me at least, is that your going to run what appear to be mundane calls over and over. "Nothing to see here folks!" But you know what? The vast majority of those calls will offer you the opportunity to learn. If your goal is to improve the condition of every pt that you have contact with you will find that EMS is interesting mostly and exciting sometimes. Anyone can run mundane calls, it's out job to spot the zebras. And I just hope to make the grade of an average medic. If you should decide to be really, really good, it gets better than that. It is what you make of it. Come to learn, and it will give you that opportunity on every call. Decide that your baseline success is to get pts to the ER alive and you'll be bored stiff. I promise. Spend a gazillion hours in class and clinicals and you can run a taxi, or you can explore each and every pt, find the answers they were keeping hidden from you, find something pathologic in them that they weren't aware of, and then you can be challenged and interested every day. And you know what? We can see where you'll go by the way you respond on these forums. Are you scared to ask your questions? Then I recommend you do something else. Take a chance, put yourself out there to learn? You can be a rockstar. Good luck in whatever you decide. Dwayne.

<div><br></div><div>Hey Toby. Welcome to the City. I'd would like to mention to you, though you didn't ask for it specifically, and the others that have replied, that this is an education forum. You've asked a great question, but one that shouldn't be moved to private conversation. Why not keep this discussion in open forum so that others with the same question can learn from it?</div><div><br></div><div>The issue isn't so much whether or not you'd like to work under pressure, as do you want to participate in the profession or just be another wanker?</div><div><br></div><div>Ask your questions brother, participate, let us know what others like you think...let's not do that in private. The soul of EMS is for others to learn from your experience. Please don't cheat others out of our experience.</div><div><br></div><div>Dwayne.<br><br><br> </div>

The logic actually seems pretty straight forward to me... Eyes were normal, the kid was fine. Eyes begin to bulge and the kid gets sick. So if I just push his eyes back in where they belong, then he should be fine! See? Easy! Anyone have an 'eye pushing' protocol? Ok, so, on the outside chance that that logic tree should be faulty in some way... I'm going with Wendy...though I couldn't have come up with that diagnosis on my best day. It makes the most sense based on my belief that enough ICP to cause the eyes to bulge to such an extent should cause some bulging around he fontanelles, as the scenario states that though they are nearly closed, they are not completely closed at this time. So I'm moving ICP down on my list of differentials. Get a good temp, get him naked if he's warm, and then as others have said, supportive care, but also tape the eyes closed to protect the retinas from drying. Where I work I would launch Flight for Life enroute to the hospital as this sounds like a really sick child and they'll have a 30-40 minute response to me, the doc can cancel should he decide to do so. What an awesome case and discussion!! It's been a while since we've had such an interesting case with so much participation! Cool as hell.... Also, Bushy has an interesting idea. I wonder if the hospital gave him some Phenergan or some such? No n/v in the report, but you never know... Dwayne

No need to apologize for the mistakes. That is what we do here...show that we have the balls/ovaries to post our ideas and then trust our friends to help us learn from those posts. Good on you girl. No good ideas on the marbles. Perhaps you were feeling muscle spasms/fat deposits under the skin, but probably not. I really have no idea... Also, you should ask your supervisor what you are supposed to tell your medical director when he asks why a pt with sluggish/unresponsive/varied sized pupils was brought in without O2 on board? Possible chronic issue, but possible CVA, right? It sounds like a fun gig to work, but frustrating too. One of my friends that works the Springs tells me that they spend all summer running people from the peak to below 7000ft...You should make sure you know that absolute rule on O2, and not just hearsay, as you'll have need of it up there. Thanks again for posting girl... Dwayne

But if he serves a population that has no access to these services, when compared to other countries, is he then not still 'serving his country?" I think he is. There are many of us that went overseas for a paycheck, only to find that the paycheck was not as big as expected, as well as to find that there was a much bigger payday. I've often been asked, "Doesn't it bother you to think that you may have treated the Taliban?" I worried about this for a month or so, before coming to realize that I've treated the Taliban dozens, if not hundreds of times. Many, like me, brought medicine to Afg, and were not missed at home. Others, Like Fozz, brought joy, and peace, and kindness there. They may have been slightly missed at home but provided amazing relief to those that had come to believe that they were beneath it. Which is better? I'lll follow Fozz's heart any day. Dwayne

Sorry babe, but they're not that good if they got hurt in such a short distance. And certainly not well trained unless you were having a meteor shower or some such at the same time. I'm confident, though I had some pretty screwed up pts, that I've never had anyone with resps in the 70's, Sats in the 80's. You've gone off into the ditch there a bit. And if your Sats were normal in the 80's, (As I've heard those summiting Everest are sometimes in the 60's) that doesn't mean that a tourists Sats should be there. If you had someone with their Sats in the 70's, that's a medical emergency. Idon't care what your Sup says. Untrue. Nonsense. And I'll be more than happy to debate this with your supervisor. You can adapt to that, sure. But not for the hour or two long trip that most folks spend on the mountain. If you look at Sats of 70% and say, "Oh, it's just because they're on Pikes Peak, so it's ok." you're setting yourself up for a beating. I know several medics that run up there, and it's not OK. Below 80% with matching physilogical markers for a person not acclimated to such an altitude is a problem. Foolish rule. What is the down side to giving O's at that altitude? Same question. What is the down side to O's? Where was the 'tight pouch of marbles?" Can't help with the 'marbles' without more information, and likely not then. Good for you girl for having the gnads (or overies) to post. I'm not meaning to bust your chops, only to make you think more, and better, (hopefully) on your next call. Dwayne

What is right? The fact that a near black man can become president. The fact that the political party that I find most contrary to my opinions can be in power. The fact that you can come here and say, "My country is damaged...can I be an American?" and hear the answer, "yes" as long as your heart is right. My goal in life is to start a community of like minded individuals, to live together and thrive together. I have recently had a very close friend tell me, "come to the Phillipines! It's easy!" Though tempted....I'm an American. I will make my way, with my brothers and sisters, of whatever color here, or I will fail. I've spent time in Afghanistan, thanks to my American friends, succeeded, failed, thrived and starved, all based on my basic ability to succeeed. That is the American way. God bless you all for allowing me the freedom to suceed, and more so, the freedom to fail. And if you've decided to be American, not African American, or Polish American, but JUST American, call me. You're welcome in my home any time. Dwayne Edited for typos. No contextual changes made.

I can't seem to find the link to a Blackberry app on there, only the 'iphone' products. Dwayne