DwayneEMTP

I often come here for opinions and resources to compare to the endless noise I sometimes find when searching Google. I don't get what's so wrong with this thread? Dwayne Edited for grammar. No significant change in context.

I think that I'm in psychosomatic shock due to he fact that you continue to choose to present your ideas like an addled 6 year old yet some were still kind enough to due your homework for you despite that fact... I guess you are right man, being purposely stupid isn't really a handicap most times. Dwayne

I'm guessing that you meant that the '3lead is being monitored throughout transport to the hospital'? I don't think you've created a major faux pas if you do treat as you're probably not going to cause major issues assuming your 12 lead showed no pathologies along the normal conduction pathways, but without a decent 12 lead, I'm with the others here, no need to do much here besides try and knock them down with Os, get a good history, and transport. I see the degradation that you're worried about, but in this case, unless it's being caused by a conduction pathology or med overdose then it's unlikely she's going to get froggy on you. Good question. Dwayne

I think Docharris has your answer then brother. RN gets you more blood and guts, more respect, more interesting medicine and the better education for when you begin to think more about supporting a family than fulfilling your inner destiny, (Not making fun, being fulfilled is certainly important, 'specially when you're young, but it won't always be your priority.) I'm sorry we couldn't give you better news, but truly, when you look back at the world from an RN's job, money, and opportunities you may be grateful you were forced off of the EMT path. Dwayne

Hey Joseph, welcome to the City. You can be a rockstar EMT with a seizure disorder, the problem is that no one is going to allow you to drive an ambulance. We had a great EMTB here a while back that had a seizure secondary to medication in Florida and I believe that he was removed from his regular job and would be required to be seizure free for a minimum of 5 years before he would be allowed back on the street. Fortunately he found a job he likes even better working in a hospital. There may be exceptions to this rule, but I really doubt it. Good luck to you man... Dwayne

Over qualified. Sorry brother. Though they might give you a second look after you explain your intense interest in voyeuristic anatomy... An interesting note. When I flew down to meet you guys in Florida I noticed I'd kept my Zippo lighter in my pocket and thought, "**** it. If they take it, they take it." One of the guys pulled it out of the tray, flipped the wheel and it lit right up. His supervisor said, "It's ok, let it go." The other said, "But I thought they were disallowed if they had fluid." First Super said, "Not any more, they're fine now." Not sure what makes me have to leave my conditioner at the counter but be allowed to take my lighter? Probably my rosy personality... Dwayne

Really? Do they record video? (Stop it! I'm not the only one that was thinking that.) Dwayne

Disagree completely. I often make suggestions to the ER staff of arrests I bring in, asking for deeper compression, slower vents, etc. Some take it well, others don't. But as long as my monitor is still hooked up and my partner is still ventilating I feel an ethical need to continue to advocate for my patient. I've never had a Dr. become offended because I attempted to keep CPR running 'my' way until I was completely clear of the pt. I've delivered to a really busy ER, and even now, with a tiny ER, busy is still relative. It's very common that I review cases that I've delivered with the docs, and when it's slow often glove up and help with pts that I'm not responsible for. I think it's a great educational resource, as well as allowing the staff and I to get to know each other, our limits, expectations. Walking away self satisfied is important for sure, but advocating for your patient is vital as well...todays pt, as well as tomorows. Dwayne Edit. Sorry, I got sidetracked. I also believe that the rate is secondary to adrenaline. I find that this is more of a problem with vents in head pts than with compressions. I sometimes have to argue to slow things down, despite allowing them to watch my ETCO2 with head injuries.

Awesome first few posts man! Welcome (still) to the City! Have you heard what the likely pathophysiology of this effect is? I can't see it secondary to simple dehydration unless it's due to the electrolyte shift perhaps...Not sure. Any ideas? Dwayne

I hear that man, and get it. I wasn't thinking along political lines when I read the post. No offense intended. Roj. I guess this concept is mostly foreign to me. I can't imagine being mauled in a bar in most circumstances. The patrons just simply wouldn't allow it. If someone hit me with a pool cue while in the community where I work they would be begging for the police to come and save them, and I don't have the most pleasant of personalities, so this is really saying something! Again, this is the rule, and as always there would be exceptions. If attacking EMS personnel is not uncommon, and the patrons of the bar would allow such a thing, then perhaps it is prudent to take away the more likely weapons. It's just....without pool, I'd have had little reason to go to bars as a kid, and without bars, very little opportunity to be around seriously drunk chicks, and without seriously drunk chicks, I might still be a virgin!! See? This story attacked me at my most basic level. I panicked. :-) Nothing funny about people being in fear of going to work. I shouldn't have made light of it. My apologies. Dwayne

Yeah, just more rules. It was my experience overseas that, at least in the environment that I lived in, there were two types of Aussies (in this context). The Crocodile Dundees, of which I met one or two, but otherwise the most amazing babies I've ever met. They need a rule for everything it seems. If someone sneezes on them, they want a rule that there be a box of Kleenex on every flat surface, if someone gets pushed they want a new rule about pushing, if someone gets threatened with a pool cue, I'm guessing they want all the pool cues removed. I love our Aussie members here, and made some very close personal, life long Aussie friends there, but the friggin' 'rule for everything' stuff made me batshit. Is this a cultural thing? Or did we just get an unusual Aussie subset overseas? Dwayne Edit: Rereading this after posting made me think it sounds a bit like I'm saying "Americans are stronger and more macho than Aussies." Nothing could be further from the truth. I was underwhelmed by the majority of Americans not in uniform that I met there as well. This was only meant to comment on what appeared to me, in this tiny subset of mixed cultures, to be a difference in rule following. The type of friends that I have most often have a real dislike of the over use of rules. It seemed to be different in the Aussie culture. No offense intended to anyone. Dwayne

Yeah, and I was surprised too, though I'm guessing others may have seen it more often. 18 y/o black male being supported by his mom, tons of drama, had bs written all over it. I had just transfered care of my patient and the ER was pretty busy so I snatched him up and took him into triage to get a set of vitals and start a history for them. As soon as he said, 'Afib' I thought, "yeah, must have heard that from your mom." I grabbed a pulse and it was really fast, irregular, it felt like Afib with RVR?? No sign of stimulants, kid looked like a jock...I felt like a bigger ass than usual. Called the doc in and it turned out he'd been seen for it several times before. They converted it chemically and he went about his way... (reported, I'd long ago left at that point.) In all the hearts in all the world I guess we shouldn't so much be surprised that this would present sometimes in someone so young, but perhaps that it doesn't do so more often. Dwayne

Hey all, I asked for and received permission to revamp our employee review process. At this time the District Manager evaluates each employee based on gross reports, (Good or bad reports from third parties) as it's the only data that's really available to him. I made the argument that in Bagram Afghanistan we rarely had any management oversight. Management was available but by far the daily operations were run in what I believe was a very competent, professional manner that those that didn't want to work, do good medicine, or simply just wanted to 'hang out' found difficult to impossible to tolerate, thus causing them to 'move on'. There was no hazing to speak of, simply a group of professionals dedicated to doing the very best medicine that they could every day. Those with like goals did well, those without simply by the 'vibe' of the environment, didn't. I'm committed to figuring out why this type of behavior can't be recreated and reinforced stateside. I'm trying to design an employee review process involves all critical input coming from fellow employees and wonder if anyone has resources to aid in this endeavor. I'm convinced that an employee run review process is the first step to recreating the same 'vibe' and environment that made an amazingly educational/cooperation environment for more progressive medics as well as a less enviting one for the 'hangers on.' See what I mean? No offense, but quips concerning whether or not this will work will have very limited value. What I need is a direction to resources to help me design it. Thanks for any help you may provide. Have a great day all.. Dwayne Edited to add text in italics.

While Barbara was doing some research on her soon to be web page, "The long ride on the short bus" she came across the article below. Skinner made these thoughts common knowledge in his day and was mugged for them, but haven't we all, intuitively, known them all along? Interesting read... http://www.rmec-onli.../sixlesson.html

I think that most would disagree with you in the vast, vast, majority of cases. Traumas, excessive time down, etc. Dwayne

By no definition is a pt with an OPA/NPA to be considered to have a 'secured' airway. Temporarily patent perhaps, but in no way secured. Every time that I've removed one of these devices and placed an ETT instead I've heard rumblings that I 'was just trying to be cool.' In my mind, dropping a tube is the least cool thing that I do. It exposes me to the teeth, saliva and all of the nasty shit that comes out of the lungs upon successful placement, not to mention it's not exactly rocket science. I can tell you that 100% of my ETTs were placed in the hope of increasing the odds of a positive medical outcome and that, to the best of my goofy knowledge, my ego was not consulted before hand. Sure, if managing this one tiny moment in time is my only responsibility. But abd distention has side effects, as does aspiration. And again, in this scenario it was never secured to begin with. I like to intubate early in many cases simply because I no longer have to effect compressions for ventilation, which is my main goal. It has the added benefit that I also stop all of the shit that tends to be running out of the esophagus because of a full belly/over aggressive bagging prior to my arrival. Our job isn't to look good, but to do good. Intubation is a great tool, and I think that you'll begin to see the difference in application as you continue your education. And I think that you'll come to appreciate (hopefully this is true) that many of the tubes you witnessed came because of a perceived medical need following assessment as opposed to a medic attempting to prove to the world that he has a penis. Great question. But I think that as you look into this further, as I'm certainly not the best choice to attempt to explain it, that you'll find that it has more to do with inter-thoracic pressure than with tidal volume. A dead person needs very little ventilation. I can't provide a sources for this, but I believe that there is argument in the CPR community over whether or not it is. Some say that more than enough air is being moved to provide ventilation, others that you are moving only dead space air for the most part. I tend to believe, based on ETCO2 during arrests, that the PPV that we deliver has limited value in the short term, but I'm still waiting for the smart folks to figure it out and tell me what to do. Fair questions LS. Dwayne

Is there any respectable body of evidence showing that any of the spinal precaution hoops that we jump through do any significant good? I'm of the seemingly unpopular belief that, intuitively, non of this, in the vast majority of my patients is worth spit. If pain is bad, in most cases, and relieving physical pain by splinting or other non pharmacological means is good, (leading to the belief of a positive anatomical/physiological shift to the positive has occurred) then I have to say I can think of very few times that I've mediated spinal pain via LB/collar. And in most cases just the opposite was true. Is this only my experience? As mentioned before, for many studies that support a body of thought, another can be expected that will show something different, and often opposite. But in the world of spinal precautions it seems that the data against just keeps piling up. Unfortunately not only the manufacturers of these types of products will kick and scream at a move against, but there is a large population of providers that have few skills beyond spinal precautions that will also feel devalued if these skills are removed and will cry as well. How does this population continue to feel heroic if we no longer need to make applying a collar and some straps appear to be 'life saving?' Pretty interesting discussion. Dwayne

Damn it! I had my money on you being dropped on your head as a baby! (Hopefully obvious that that was meant in fun...You're a gift here brother...) Dwayne

Although it sound like one of those bullshit hero stories... My first call as a paid medic on my own truck (in the U.S.) was an "Unresponsive 3 month old, CPR in progress." Can't go into it further without taking a chance on following CrapMagnet down that bumpy road... Dwayne

Holy crap, that's funny as hell right there.... Dwayne

Pretty interesting. Another example of why the scientific process is so important. We just can't always believe what we discover with our senses... The patient says, 'I'm seeing kids on the piano.' And they're right. The docs are saying 'you're not really seeing anything.' And they're right too. This happened to me a few times...but there were mushrooms involved. I don't think it's exactly the same thing, right? Thanks for posting Cutie... Dwayne

Man, I can usually play devil's advocate to just about anything..But I got nuttin' here. Hopefully this will be prosecuted as the very significant child abuse that it is. It's a crazy friggin' world sometimes. Dwayne

Yikes...it sounds like you certainly have your hands full. I'm sorry to hear of your troubles. God's speed to you and those that you love. Keep your chin up girl... Dwayne

Study group is awesome! But be forewarned. You will need to be responsible for the group. Prepare the materials, (I love flash cards as well) set the times, define the parameters for each session. You need to start it, and then you need to maintain it. If you wait for others to help you, you will be sorely disappointed. And you MUST, MUST, MUST have the cast iron ovaries to eliminate those that only want to participate at a minimal level or in the last few days before an exam. Surround yourself with winners, give the mediocre students a chance to become winners, and blow off the dead weight. That's vital. DO NOT FEEL THE NEED TO MOTHER THOSE THAT ARE UNABLE OR UNWILLING TO COMMIT THE TIME AND ENERGY NECESSARY TO SUCCEED AT THE LEVEL YOU DESIRE. (Can you tell that I think that that's a pretty important point?) Also, break down the names of each of the anatomical terms that you learn and come to understand the word parts. You can memorize 12 gazillion names of muscles, bones, anatomical markers, etc, or you can learn a few dozen word parts and their rules that will allow you to simply state the likely name based on shape, location, and/or anatomical purpose.. It will make life SO much easier...trust me on this one. Good luck girl. A&P classes are usually full, but there will almost certainly be openings in the first week after many find out that this class is actually going to be work. Keep your chin up. Dwayne