DwayneEMTP

I'd be willing to bet that he's referring to a possible increased risk of transmission from the exhaled neb. In the future you might want to reach a little and begin by assuming that the poster is not an idiot. To imply that reuse of his disposable nebulizer was the crux of his issue is short sighted, and a little silly. Again, I don't believe he was asking for an opinion as to how 'it sounds' but for people that have experience with it and can offer an educated opinion. Not trying to bust you chops brother, but you've made a poor start... Most of us did when we were new here. Welcome, and I hope you'll stick around. Dwayne

Unfortunately it's already proving to be a popularity, not productivity contest... If we can now just get folks to vote based on post content instead of warm fuzzies, life will be good. Or at least better. Dwayne

Jenny Mcarthy...Grrrrrr...how can anyone that looks so good naked be such an idiot?? It's a crime... Thanks HERBIE1 for the info. But that raises another question. The N1H1 vaccine has only been in testing since August, but aren't all flu vaccines developed, tested and despensed in the 11th hour? Isn't that kind of the nature of the the flu vaccines? I have no time of late to research anything, so I'll just talk off of the top of my head. But I thought that the majority, if not all of influenzas started in, China I think? And then are spread around China by water foul until it starts to spread more globally via migrating birds, and people. So...It seems that we 'normally' have a fairly reliable timeline for dispersal of the illness and thus an approximate target date for development, testing and delivery of the vaccine. Development in the summer, testing in the late summer/fall, delivery in the winter. Not sure of the accuracy of these thoughts, but other than the hysteria surrounding H1N1, is the development, testing and delivery schedule of this vaccine really that different from those that have come before? Dwayne First edit to because I forgot to left orient, second edit because I forgot to explain my edits. No other changes made.

Good to have you back man! Dwayne

This is hilarious... Though I do applaud them for making the changes the rest of us are sitting on our hands waiting to become formalized. Dwayne

Yeah, I'm with Dust. That's why you like it! Every few months we get a post telling how you got your ass kicked, yet it's all good. If it was slow we'd hear from you every day about how bad it sucks! :-) Sounds like you did real good Lady...Get some rest. Dwayne

I've seen posted here over and over about the reported side effects, and the fact that this vaccine is being pushed out to healthcare workers without being 'fully vetted.' Could someone please post sources for these claims? They come from some of our more respected posters, so I'm in no way calling bullshit, I just haven't seen them and found that none came up easily during a Google search. Thanks for your help. Dwayne Edit. That's weird, these were actually two separate posts that the program combined into one...anyone else have this happen? Other than making this note, nothing else was altered during the edit.

Welcome! Your first post gives much hope to your time here being very valuable, to you and us. Thanks for sharing your thoughts. Dwayne

Thank you to all for the love and prayers that you've posted in this thread. I'm sorry I haven't visited it more often. I hope you'll believe me when I tell you that the thoughts sent from here did in fact catch her attention and reiforced her strength and resolve. She died in her sleep, unexpected as to the time, but certainly not to the eventuality. Wendy, Kaisu, she knew you by name and counted you as friends. There is nothing you'll ever be able to ask of me that I wouldn't immediately do to repay that kindess. She is having a wake (I think it's called?) tomorrow and then her funeral will be in CO Springs on Saturday. They are having the services in the school gym as there are over 500 people extected. She was truly one of God's special people. Though she was tired, and ready to leave this world, she was also very excited to explore whatever may come next. I can't imagine that if I should live a long life, full of trials, that I'll ever be gifted with her faith, kindness, spirit and will. I don't have the right words to express what many of the thoughts in this post mean to me, so I'll simply say, Thank You, again. Have a great day all. Dwayne

Is it just me or does this whole concept, where intubation is concerned, seem ridiculous? No one in the hospital had any idea how to intubate? They had a Glide Scope but were unsure how to put it to use? At first I thought that perhaps they simply used this case to verify that the video would work remotely, but then of course that could be done with a mannequin and this was said, and certainly sounded like, an emergent intubation. Remote surgery makes sense to me. One specialist to be everywhere at once. Remote intubation? Why spend a gazillion dollars, (well, the scope is around $13,000) to accomplish a skill most can learn in a few hours? I must be missing something... Dwayne

Definitions of EtOH on the Web: Ethanol, also called ethyl alcohol, pure alcohol, grain alcohol, or drinking alcohol, is a volatile, flammable, colorless liquid. ... en.wikipedia.org/wiki/EtOH

You are absolutely right on all points. Devil's advocate.... Though I've run on attempted/threats of suicide that I would be unable to prove were in any way altered, (calm, lucid, drug/alcohol free)we still manage these patients with transport, right? Even against their will if necessary as we've found that though they are mentating in every way 'normally' these types of thoughts are considered 'altered.' (in an effort to keep the thought in context.) So could it be extrapolated that if purposely planning to take your life via mechanical means is 'disallowed' as damaged thinking that then choosing to risk your life via non management of an relatively easily managed disease might be so as well? Is evidence that you're willing to willing to cause/allow/or in some way bring about your own demise defined by semantics, or intent? (Of course, should this pt have a DNR for this, or some other reason, I would consider this argument moot.) Can the argument be made that by treating this patient in place, with the belief that he would refuse, actually be the choice that will put the patient at more substantial risk? Is he better served to be awakened and then left to suffer his next crisis alone, which is nearly assured, than to have his treatment monitored even by a half assed paramedic for the few moment trip to the ambulance? Thanks all for your responses! This is an awesome exercise! Though perhaps more easily than before, with the last several posts it's easy to argue that what was done was right because it feels right. I'd ask as a favor that we continue to follow Fiz's example of staying focused and within the parameters of the argument. Not because the other points of view are unimportant, or uninteresting, as I find them just the opposite, but simply because we're gifted with having many of our most valuable posters in this thread and it will help us all stay on track. Thank you all for participating in the very best spirit of EMTCity...that's cool as hell. Dwayne

Nod, I get that. But it seems what's being said is that, if we use the given numbers, the total cardiac output during CPR, at best is 20%. So somehow that meager volume of blood will drive the blood backwards, through all of the veinous valves, back through the capillary beds, with enough force and volume to create a femoral pulse? Does this make sense to everyone else or am I the only one that's not getting why/how/if this happens? Dwayne

Fiz, your assumptions are all correct. And of course there are no hard feelings, your honesty and intelligence is what makes you such an asset here! Your point is taken in the spirit intended, but should I have chosen to act differently, and in fact generated a refusal, given this patients history, what then if he becomes worse, strokes or seizes not long after I'm gone? Is that just an 'oh shit' moment? Or is there moral liability there for the provider? Chatting with Wendy made me think... This may be akin to pulling the sober, though homeless man into your ambulance so that he can warm up and then turning him back out into the snow and expecting him to stay warm from now on. Do you have an obligation to to attempt to coerce, cajole, trick him into going somewhere warmer if you believe that releasing him brings the likelihood of life ending hypothermia? I don't know if I should, I just know that I would...but there's the rub.. Dwayne

I don't use femoral pulses. I use depth of compression as the only indication. Could you explain 'retrograde blood flow?' I understand the concept in the abstract, as in retrograde depolarization, but as one that likes to believe he as at least a feeble grasp of anatomy and physiology, I can't seem to develop a clear concept for creating significant 'backwards' blood flow. Thanks. Dwayne

Thanks a million Yeti...That's cool as hell. When you get stateside next lets try and get together and spread a little hate and discontent? No Yeti snacks on Dylan's site, but I happen to know a few things that at least one of them likes... I know, Canon City isn't as cool as going to a Filipino she male bar, but we'll do the best we can! :-) Thanks again brother...be safe. Dwayne

Hey all, Dylan's class is selling charity stuff as part of one of the autistism "life skills" programs provided to him at his school. Part of the money raised goes to help support his special needs program, and others like it. Plus, if he meets certain goals he gets prizes of course.. No pressure, as I know many of you have kids doing the same kinds of things and a person can go broke buying candy bars, popcorn, magazines and such, but if you'd like to participate you can do so at the link below. www.abcfundraisinginc.com/store/brochures.php?sID=har6657 Thanks guys...have a great day. Dwayne

Oh hell...thanks man. I guess I'm just used to seeing them on the left side of Word, or was on drugs, or...who knows. Thanks again. Dwayne

As I was relating this story to Babs tonight, it occured to me that they really missed the boat by taking the low road with this situation... I mean, how many nursing homes can claim to do such a stellar job that they need to keep their residents from sneaking around like snickering teenagers? They should have challenged nursing homes nation wide to prove their quality of care by posting their 'orgy' count. They could have made national news if they'd simply, tongue in cheek, explained their formula for 'pumping the youth back into their program.' (Pun intended) Hell, I would have put my name on their really, really long waiting list today. Dwayne Edit to attempt to replace center format with Left format, which, obviously I was unable to figure out how to do... :-)

Hey all, One of the guys I work with is a fire medic and we got into an argument this morning concerning Fire and EMS. My argument was that most of the times that EMS has attempted to make a run at creating an entry level AAS for paramedic medicine that Fire has consistently opposed it. He claims that this is nonsense, that the fire unions are pro education and responsible for many increases in EMS education. I'm looking for articles, as I know I've seen a lot of them, to support my argument that Fire consistently stands in the way of increased education in EMS. I have no doubt that both arguments can be supported, but I am looking for support for mine only. Though I would be interested in seeing another thread to support the opposite if possible. It is not my intention to start a flame war here. I have many, many friends that also happen to be infected by the Firebug. This is a good natured argument between a medic I respect and myself and I simply want to smite him in a good natured way. I simply don't have the time, or the mad Google skills to do so on my own in short order. I'm asking as a favor that we avoid having this thread locked by keeping it in that spirit. Thanks for any help you can provide. Dwayne

Yeah, I guess I did. I had a reliable history that told me that I was likely dealing soley with a hypoglycemic emergency. Which follows, in my mind, that I could have temporarily corrected that issues and returned him to his normal mentation, and then left him, per his predicted wishes. So I don't believe that my decision to withhold the sugar until it was unrealistic for him to refuse was a benefit to his medical treatment. But I do believe that 'forcing' him to a place where he would recieve what I believed to be the more appropriate medical treatement, as well as the possibility for ongoing care, was best for him.' So ultimately I forced him to recieve medical treatment that I believed he would have refused if able. Now, in hindsight it turns out I was mistaken. He was grateful for the treatment he recieved from me and for the opportunity to more fully resolve the issues he'd been suffering. Now, I'm comfortable that my treatment was strictly patient advocacy based, but do we have the right to advocate for patients against their properly mentating wishes? Or to withhold the opportunity to properly mentate, when it's within our power to give it, so that we can gift them with our advocacy? (Yikes, sounds terribly arrogant when put that way, doesn't it?) I'm no longer crunching this issue from a conscience point of view, but still certainly find it interesting from a philisophical point of view. Thanks to all for your responses! Dwayne

Man. Good question. Do I question their right to refuse treatment? No, not so much as I have the right secondary to implied consent. I've never known the wishes of an overdose, but if I did, without the direction of an attending physician, would not feel comfortable following them based on the fact that the overdose seems to signify an inability to maintain the reliable mentation necessary for such a decision. Exactly. No, but I once chose not to work an arrest that happened in front of me based on the patient's, reinforced by the family, wishes that he did not wish to be resuscitated. No DNR on scene, or even issued in fact. But see, this is where I seem to be a freak, in that I have less desire to defend myself than to I do to make the 'right' decision. In the arrest I mention above, I really had little defense had the family changed their stories afterward. I did make sure I had police witnesses to all statements but did not get them in writing. I couldn't tolerate the thought of removing his last opportunity to exercise his personal power. This PCR was called to the attention of my medical director, by me, who suggested I do more to protect myself in the future but had no issues with the decision. I actually see these issues at the heart of paramedic medicine. I have only very rarely been at a loss for the appropriate medicine to use at a certain moment, but find that I am regularly challenged to decide the 'right' and 'wrong' from a moral/ethical point of view. Thanks for your reply Matty. I look forward to your thoughts. Fiz, Coz, aren't these issues right down your alleys? :-) Dwayne

Oh my God. How old is he? Hmmmm...looks kinda old, acts like a child...Are Yeti years like dog years? Hell, who knows. Happy birthday ol' man. Dwayne

Holy crap! Am I the only one that noticed that the naked women outnumbered the naked men two to one?? That's awesome! Gotta love their attitude. They wanted to live, wanted to party, wanted to get naked. (A decent orderly would have sneaked them in some herb..just sayin'..) Stay the hell out of their way. I believe that if we allow DNRs so that a person can decide the way that they wish to die at the end of their life, then they certainly should have the right to decide how they want to live at the end of their life, right? I feel 20 years younger just hearing that story... Dwayne Edit: Though I'm not sure I understand the "not so much funny as sick" statement?

Holy smokes all...this is awesome! I truly expected that this thread was going to be ignored. Both Fiz and Matty are correct. I have on occasion done things I felt were in the best interest of my patients but believed would get me a beating later, and have had no real issue with it. This was different from the point of view that I truly believe people have the right to be the pilot of their destiny up to, and including deciding to die. I'm thrilled that so many of the people I respect here were kind enough to voice an opinion, though I truly believed that many of those opinions were going to be negative. I just couldn't find a good place in my head for this for some reason. Did I do what's best for my patient? I believe I did. Does he have the right, when mentating properly, to choose to do things NOT in his best interest? I believe he does. Did I believe I knew his wishes when I chose not to attempt to restore his mentation before transport? I believed so. Do I have the right to make that choice for him when I believe he might cuss me for it later? For some reason I believed I did. Will I next choose to work the viable looking 50 year old with a DNR because I believe I know better than they do? No, I will not. But what is the difference between these two patients? Why is one decision good for one, but not the other? It seems right, I just can't define why it IS right. See? See what happened? I nearly ended up in vapor lock. This patient in fact did not cuss me when he awoke. He realized that something was out of control, that it was threatening his life, and wanted to get it resolved. Whew. Thank you all for your time, and your kind and honest answers. I am with Matty though. I'd like to figure out what makes it right, or wrong, and where the lines are drawn. Right now I feel like the judge that said something to the effect, "I don't need to define pornography! I know it when I see it!" I didn't like his answer, and though I feel good about my decision, don't like my answer either. Dwayne