DwayneEMTP

I agree, great post. But, in the interest of improving us all, What "important information" was released? We're all better off with accurate post headings so we can focus in on those things that interest us, or that we believe we have something to contribute to. Thanks for posting and contributing to the site! Dwayne

Prayers for peace and strength for those that loved her from the Womacks in Colorado. Dwayne

Who here sees agonal respirations as a sign of life? Just curious... Dwayne

Hey Harry, welcome to the City! Can you explain where you feel that your statement is obvious? Not calling you out brother, just trying to see your point. I don't see anything described so far that labels this a tramatic arrest as opposed to an arrest resulting in some significant trauma. Two different things in my mind, though perhaps I'm ignorant of the correct definition of traumatic arrest. At this point I'm not really comfortable calling this a trauma code at all. The pupils are almost certainly secondary to the head trauma, though as Celtic said, and I unfortunately never considered, we're not even sure of that without a history. I treated a child brought in by his father in Kandahar. Exposed brain matter from an open cranial fracture secondary to being thrown onto a rock after being hit by a car. As I began to open my inubation kit I thought I heard him talking! Sure enough, he was yacking away with his father who claimed he was "awake" the entire time. He screamed like a banshee when I started my IV. At no point did I uncover a single neurologic deficit! I know, sounds like bullshit but akflightmedic is familiar with this child, and I believe the specifics of the case, so perhaps he can verify it's accuracy. Same child, blown pupils, no respiratory effort, etc..etc..He's almost certainly dead. I would still work him in Afg. as I needed the practice with Peds, but perhaps not here. I'm certainly not advocating that we should "work everybody!" I'm just saying that in this case there is not enough information to go anywhere near a moral/ethical decision to withhold treatment, at least not that my little pea brain can find. What do you see that I'm missing? Dwayne

I'm a little surprised to see that so many assign the possible mechanical failure of this guy's heart to the accident. I saw somewhere, perhaps here, that as many as 50% of single car accidents that cross lanes of traffic have a cardiac element, perhaps bicycles too? What evidence, if any, is there that the arrest is cause by the trauma and that a mitigatable factor didn't cause the arrest that then resulted in him being involved in an accident? Lots of blood and "gray matter" at the back of the head shouldn't immediately define this as a code to walk away from. Until I eliminate the causes of PEAs, specifically, and other causes that may have caused him to enter this accident, generally, then he gets worked...not like they're taking the drugs out of my pay. Dwayne

Just curious... Why would you think to sue the patient instead of workman's comp, the entity responsible for your care and rehab? If you are called to pull a person from car accident wreckage after they have been hit by a drunk driver and you slice your head on a piece of hagged metal and become septic secondary to the wound, do you sue the family because you had to perform the job you've signed on for? Should you find a prehospital medical position that allows you to lift only thin people in wide hallways with no inclement weather I'll pay you good money for information of getting hired at that service...Let me know man, many here will tell you I'm good it.. Dwayne

I think there were maybe 4-6 questions on my NR that referenced medications, and with one exception the correct answer was always not to use it. The one medication the test demanded and answer to I'd never heard of...I can't remember now what it was called..and I'd never been exposed to it, but by breaking down the name I was confident of the drug class and only one of the sets of symptoms fit that class. Time spent worry about drugs on the NR, based on my experience and those of anyone I've ever talked to that took it, is time wasted. Having said that...you should know your pharmacology inside and out of course to be able to provide competent patient care, just don't worry about it for the NR. Dwayne

Happiness, sorry, I forgot your other point, yet again I believe you misunderstand. I don't claim that dogs don't have feelings, that they don't have pain, only that people attempt to endow them with human intentions that don't fit. I just came from Kandahar, Afghanistan. Because I was acting like an idiot I got caught out in the open during a rocket attack (not nearly as big of a deal as it sounds) and some Marines came out and got me in an uparmoured Hummer. Had they been hurt, I would have been very upset, as they made a calculated choice to come out instead of stay in a bunker or go someplace safer. They did the cost/benefit analysis of seeing their families and loved ones again compared to doing their jobs. I have nothing but respect for that. When Fido is sent after a fleeing suspect he's not doing it for honor, or making sacrifices for his fellow sentient beings, he's doing it because chasing and attacking things satisfies his instinctual hardwiring and makes his nipples hard. He's pleasing himself, and that is all that's in his mind. I can respect that too...I just simply don't confuse the two..See? Do I have compassion for a dog in pain? Very much, I hate to see it. But I would give it little to no thought if allowing that thought meant that a human would suffer instead (and for the umpteenth time I'm not claiming that's what happened, only positing the hypothetical). I don't think any decent person would leave any living creature in pain if they had options, it's simply that, in this thread, being unwilling to say that I don't believe them to be equal to humans in value offends some people. CBEMT I'm completely confused by your post. You quote my post where I make it clear I'm not calling these guys out, nor believe they should be punished and then claim I said they should have done something different and be punished. What's up with that? Dwayne

I'm not sure that I implied that is was simple, only that we're paid to be problem solvers, or at least I believe I am. I didn't see why it needed to be newsworthy that a paramedic solved a problem. This whiney nonsense is the main reason I don't post much any more. There was a time, not far past, when a thread in the EMS Discussion forum couldn't have made it three pages without a single critical comment. Sorry brother, this forum is for discussion so you need to take a check when you're entire post is to complain that I Killed your 'warm fuzzy.' Please attempt to show where this happened so that everyone can see that you're just making shit up because you can't make a valid point. I specifically said that my feeling on what happens to "these two" would be based on the amount of time they were distracted by the dog. At no point did I even imply that they did anything wrong, I simply criticized those that wanted to praise them based on a bunch of feel good bullshit when there are scenarios where they might possibly have been shown to be very irresponsible if all information was given. I've often liked your posts, but you're off in the ditch this time man. You want to know when paramedicine has gained at least a modicum of respect? When someone says, "Holy shit! Did you see that? The medic treated that dog and got the patient taken care of in no time!" And the reporter, instead of calling his editor simply replies, "Of course man, that's what they do." As long as the public thinks it's a miracle every time we accomplish an unusual task without calling the fire dept then they are also going to continue to believe that we're idiots. I don't care who is in them, only whether or not they are allowed to endanger human lives by running lights and sirens to save animals. Good for you, but I don't care what made you feel kind and superior, I care what you know about emergency medicine, and you thus far have nothing to offer us in that regard in this thread. Yeah, I get that a lot... I think you'll find that Dust's posts will be superior to mine in most ways on nearly every occasion. I suggest you simply skip mine and read his. Whaaaaa. Again, what you seem to miss is that they are also productive. Productive trumps your seemingly delicate feelings. You seem to be having issues understanding that this isn't all about you and your feelings, it's about truth. Truths we know, truths we are trying to find, easy truths, and yeah man, even some truths that you may not like. But we often get some hotshot that gets a few posts and begins to believe that he's so loved by those in the chat room that he should come out and police the forums. Good luck with that. Thanks for you post Happines, but you also seem to misunderstand me to be claiming that these medics acted poorly. I didn't say that at all, as I think you'll both see if you reread my post, I simply claimed that I was unwilling to applaud them without more information. I, as you, have not one friggin clue what happened on this scene. I was simply asking.."what if?" Too often now the City seems to be about high fiving each other and being touchy feely instead of being critical and curious, which is how we all learn. It wasn't my intention to offend anyone with my post, only to question one aspect of the article, and to bring into question the comments of some posters that seemed, to me, to equate animal life to human life. I think we could all learn from both lines of thought. If my attempts to learn, and educate sometimes means that we have to try and wring bullshit from a fluff piece in the newspaper? Yeah, I'll take my beatings and choose learning every time. And Happiness, I almost always enjoy your posts as well, including this one. Have a good day all. Dwayne

I'd be curious to know how long it took to track down the vet that gave them advice on the morphine dosage, and I'm a little bit surprised that nearly everyone here is so gushy with praise without more information. Would you still feel they did the appropriate thing if it took 30 minutes to find a vet to consult? How about if the time they spent tracking down the vet led to additional morbidity in the damaged fingers? Or perhaps other limbs secondary to the bite wounds? I'm not faulting them for dosing the dog to get the patient to agree to treatment, and not pretending I wouldn't likely have dumped "some dose" of narcs to knock the dog down so I could continue to do my job, but to me it's important how much time they spent fussing over the dog when treating humans is their moral and ethical responsibility. And I have serious issues with those that claim that "Animals deserve the same care that humans do!" Bullshit. If my son and the neighbors dog get hit by the same car you had better not have any trouble figuring out who needs treatment first, nor who has the greatest right to that treatment. Humans are humans, dogs are dogs. At some point people started the "He's a canine officer" bullshit, believing the hype the same way most have come to believe that all firemen are heros. The dog is as much an officer as his gun or nightstick. He's not acting with 'honor', he uses no discretion, he's not risking his life to save yours, he's fulfilling his biological programming, following reinforced opperant behavior. God bless the animals. But if he's keeping my patient from accepting treatment then I'm going to dump some morphine on him to mitigate his suffering, but I'm not going to spend any time looking for a vet. If my dose is good...Awesome. If not, then my patient can be pissed at me from his recovery bed. Either way, my responsibility is to my human patients mortality and morbidity, not to try to gather press Kudos for "loving the lesser creatures." And the last thing we need is a bunch more of those untrained "Pet ambulances" screaming over the roads lights and sirens. Again, not because I believe animals have no value, but simply because I believe that they don't have enough value to risk my family's safety by running lights and sirens to save your pet. And for those that don't know me, I've spend over 20 years as an animal behaviorist. Ive trained police dogs, prison dogs, SARs dogs, personal aid dogs, amongst thousands of others. You'll be hard pressed to find anyone that respects animals more than I do. I just simply refuse to confuse them with humans. I don't believe discipline for these men is necessary, assuming they didn't take an unreasonable amount of time contacting a vet, but I also don't believe that solving this simple problem calles for national/international recognition. Solving problems is what we do, right? Dwayne

I'm curious as to the mechanism of the interosseous pain that would need to be mediated? Since seeing this question a few years back here at the City I've made it a point to ask anyone and everyone that has ever had need to use an IO device this question and all have said that there was no significant pain with infusion. The doctors, Perhaps a half dozen, whom all claim to have started "numerous" IOs claim that there are none of the necessary receptors in the IO space to cause the stated pain upon infusion. Anyway, I've seen here where people in this thread have claimed that this is "the worst possible pain", but I can't find the mechanism, with only a small amount of Googling, and the doctors that I have talked to claim that it CAN'T exist, so what's the deal?? I'm not even sure what the receptors would be? Mechanical, thermal, Chemo, Barro, stretch? (Yeah, I know, I'm a few years post A&P so I'm probably mixing and missing them) Anyway, to those that claim that a lido bolus is necessary prior to running fluids to mediate pain I'd be curious to hear you explanation. Thanks all. Dwayne

Hell, I thought this was an awesome, much too seldom asked question! Why did I want children? I believed that becoming a man demanded that I fight, smoke, drink to excess and reproduce. Pretty shitty reasons, right? Boy did fate have a curve ball in store for me!! Awesome question man, and one we'd all be better off having to answer before reproducing...and I don't see the reason for the offense at it's asking unless you don't really have a reason...just sayin'... Dwayne

Not EMS related, but one Babs liked... "If you're going to ride my ass can you at least pull my hair"?

I just browsed through the article, but it sounds like all he's really saying is, "Don't confuse a patient in compensated shock for a well patient." Really? Learning point for those newer to the profession. If the answer is obvious to you, please don't answer. What s/s/other means would you use to determine that a patient is in compensated shock as opposed to simply being a well patient? Also, please don't quote your books, let's use our heads and walk through the physiology instead... Dwayne

Sorry Mobey, but this is a silly comment. If money was no object would it make sense to have a full body scan analysed by a professional once/year? Sure. But that's not realistic for most of us, so how about if we use logic, common sense and science to tell us not only what is most likely, but that which is likely to give us terrible discomfort while we perish, unless caught early, in which case is often easily managed and cured? It sounds as if you're saying that if you can't do everything, then there is not sense to do anything? Please say that that is not your opinion. God's speed to your husband Lady. He's got a lot of challenges ahead..I wish he, and you strength and good humor. Dwayne

Poof, your wish is granted. You now have no short term memory. I wish I could heal with the touch of my hand...

Happy birthday babe... I got your wish list, but if I actually gave you all you asked for I'd be tied (#3 on your list) up in confessional for a month! And we're shy on confessionals here.. :-) Love you Kaisu, you're smokin' hot for a 29 year old! Dwayne

Not sure. But I am sure they shouldn't lose their medical certification based on something that had nothing to do with medicine, nor the ethics or morals of medicine. It seems that the spirit of the passages you posted involved hurting, or even disappointing patients. I don't see where they intended for people to lose their certs based on anything someone might consider foolish. Should you lose your certs for cheating on your spouse? When it's discovered that you've not provided realistic amounts of life insurance to care for your family if you're killed? When it's discovered that you daisy chained your extension cords to run all of your Christmas lights? I believe all of these things to be much more foolish than sliding around an empty parking lot in the snow, something that everyone that's ever lived in snow country has done. So do we also call for the certs of anyone doing any number of foolish, non medical, non patient contact types of things? Dwayne

Nod, but that was conduct or care rendered. (rendered; rendering give; submit; do; provide.) I don't think, from the descriptions here, that there was any rendering going on, just foolishness. I'm not sure we should call for the revocation of someone's livelihood simply because they irritate us. And all is well brother, just been busy. Take care. Dwayne

It seems like, though I'm not going to take the time to look it up, that not so long ago many of these same people outraged in this thread were arguing that we should let these people carry guns if they chose to, right? And by what authority would they lose their certs? Be fired, possibly, but to those that said they should lose their certs, I'd be interested in your justification. I didn't watch the vid as it would have taken me hours to download it probably, but it sounds like horseplay. Not even an employee issue nearly so much as a management issue. Just sayin'... Dwayne

How do you know exactly why they were fired? If there is more than one person in the chain of information you recieved then you are operating on rumors, and no one is going to thank you for accusing someone of something you can't verify. What will be the boss and crew's reaction when it becomes obvious that you're trying to torpedo someone you don't like as opposed to trying to protect the company? I'd answer these questions before moving forward if I were you. Dwayne

No? Men's room, 3rd stall from the end, left wall...it's all explained there...please forgive the penmanship though, as....whoever...wrote it there found it challenging to write on a painted wall with a Sharpie. And the anatomical drawings may or may not be representative of any actual person...Just sayin'..... Dwayne

As you should. Your post was a little unorganized, which is expected when your new, yet a bunch of experienced members felt the need to jump in and act like assholes but you still decided to come back with a positive post. That certainly puts you in a completely different category than nearly everyone in this thread. I have a lot of respect for the fact that you even came back to this discussion. It shows a commitment to contribute and a willingness to ignore the ignorant in order to try and learn, I like that a lot. You do what you do, the fact that there are people that can tell you that they do more...that doesn't mean they do it better, or with more honor or dedication. If they do medicine with the complete lack of logic that they’ve used to respond to your post then I’m guessing you’re a much better provider despite your low number of calls. Yeah man, I'll do you one better. I've not been doing this as long as you, and I sometimes feel like I'm about 4 months prior to getting my card. One thing that I've discovered is that it's easy to keep your knowledge and skills up when you’re busy, as well as bullshit arrogance, as you've seen here, but friggin hard when you're not busy!! Just make sure you watch out for that. I've not been doing this long enough to answer your question for myself, but I can tell you this; I work with akflightmedic, who's been doing this for a few days. He's done a lot, been everywhere, and he still runs to jump in the truck to go on calls. He seems to be excited about EVERYTHING! Loves the medicine, loves the patients, finds a way to get something from, and give something to every partner. We have medical discussions/arguments nearly every day, most days several times, and nothing makes him happier than if you make him say, "I don't know...." I've found his commitment to his craft, and people in general to be unusual, and I'm not sure that you'll still feel the 'rush' if you don't share it with him. But if you do? I can't see any sign that you need to be worried about the thrill going away. A piece of advice, meant friendly? People judge you here by the way you present yourself in your post. Be careful of your capitalization, use the spell checker, and NEVER hit the submit button without rereading your thoughts at least once, ok? Welcome to the City brother. Sorry for the idiotic responses to your post. Dwayne

No worries Ter, for some reason that sounded funny in my head, though rereading it I'm not sure how. Thanks for the update. Dwayne

Yeah, seems like a notice to get well would give some idea of what one should get better from... Feel better buddy... Dwayne