DwayneEMTP

You two are talking at cross purposes. He's correct, but he's speaking about a mid delivery scenario where the cord can be crushed between the child and the birth canal walls. You are correct, but are speaking post delivery..apples to oranges...see? Dwayne

Yeah, I had to read that twice, as the first time I read "Eydawn". Only upon review did I see it was actually a sentence and not just a name.. Just sayin'.... Dwayne

This thread obviously illuminates the need for further education in EMS as it makes it clear that none of you has stayed current with the latest literature on the subject. See below.

Awesome post, and great thought. I actually thought the same thing, though didn't have the balls to post it. It makes sense to me if you assume that there is an issue, know what I mean? If you KNOW that there is such a negative physiological result, then this logic lines up well for me. If you assume that there is not any such issue, then it does seem to me that the body is going to compensate almost immediatley, if not sooner, for any change in pressure that a temporary brachial occlusion would be able to provide. Thanks for you thoughts man, and welcome to the City! Dwayne

I think these are the best questions, and most often missed in standardized tests. They force one to walk through multisystem anatomy and physiology, which is where many, including myself of course, are weakest. I'm almost certain that I didn't have a single such question on the NR. I for one would love to see your questions. Dwayne

Man, Doc, that's way exciting! Good for you and your misses. Prayers for health and quick recovery for mom and baby, and peace and happiness for you all... Dwayne

Yeah Crotchity, really bad form to announce your "possible next thread" by hijacking this one... Just sayin'.... Dwayne Edited to correct capitalization only, second edit because I forgot to explain the first.

Well DH...I'm flattered that you'd think I would qualify under the above description, but I'm not even close. I was actually hinting at another member here, some of us in Afghanistan call him Yeti, for reasons that are obvious should you meet him in person. And with previous MODERATOR experience, it seemed like it might be a good fit. But it's ak...I mean Ok if he's not up for it..I don't want to put him on the spot. Have a great day all..... Dwayne

If they made disparaging remarks about his home, and weren’t misunderstood while talking about it in an effort to gather objective data for treatment, And if they spoke of his 'worth' instead of his viability... And if they spent time, while he was alive, to get their stories straight justifying allowing him to die, and then lied about it... And if they did in fact withhold proper treatment, (I saw what they are accused of saying, and that he died, but didn't see specifically that they didn't ultimately treat.) Then I hope they are fired, humiliated, go to jail, have a very unpleasant time there, and never be allowed to pretend to represent the morals and ethics of EMS again. Dwayne

Yeah man, outstanding idea! Can I suggest a moderator to filter your questions before making up your final document? The reason I say this is that the questions should be a quiz, but educational as well, you don't want to incorporate all the questions from every limp weenie that wants to play, "stump the City" instead of participate in the spirit you intend..see what I mean? (My opinion only of course. Not trying to challenge your idea.) Now where could we find a moderator? Hmmmm...someone with experience in EMS and teaching, done everything, perhaps stuck in a war zone with a little extra time on their hands, has a good grasp of testing concepts, already has 'moderator' attached to their name...Hmmmm.....nope, I got nothin'..... Wait, is that a volunteer? Outstanding!! Great idea though! I too will try and participate to the best of my ability. Dwayne

Really? Regardless of pt age, history, current medical condition? Not sniping, I'm just curious. So given the pt above, minus dependent lividity, you would choose not to work him based soley on the relatives say so? Dwayne

I don't know man. Became a paramedic a couple of generations before it was required, continued to do it long after it was no longer required, I'm guessing. He's of the generation to brag about 'jumping' calls, as opposed to avoiding them? I just can't find anything here not to respect. He's a hosemonkey, sure, but no one's perfect. God help his wife with him home all the time though.... Wishes for he and his family that he have a long, healthy, full retirement. Dwayne

Hell, I'd assumed it was the context of lost in a 'snow storm"...confused, unable to find your own way. But I guess I'll give you the the benefit of the doubt and go with your story Doc... :wink: Dwayne

Certainly not an appropriate medical term in my world, but I’d hold off on stringing those involved up from the gallows just yet… I would certainly 'snow' a pt I needed to intubate. But I once snowed an older gentleman with an OD of Promethazine, because he became much more sedated than I had hoped. He was protecting his own airway...so not snowed in the sense of intubation, simply beyond what I had hoped, or what was productive for him... I haven't used this term except in casual conversation (Man, I just wanted to manage his N/V but ended up snowing him instead), never in a professional setting (Yeah Doc, he was seizing, so we decided to snow him), but I would define it as any altered mentation brought about pharmaceutically, from slightly confused/disoriented, when neither was desired, to completely obtunded, which is of course what makes it an inappropriate term unless all involved have defined it in exactly the same way. Kind of like saying, “Man, ak really got “lit” at that party!” What is lit? For me, and the company I keep, it most likely means he got a little drunker that he would have liked, was silly and funny. In different company I’d have to wonder if we’re talking booze, or pot, if he got into a fight and someone “lit him up” verbally or physically. Lit works here, because it’s unimportant if I understand the exact definition or not, as someone is simply passing me information to use to give him hell with later. If his health is involved then we certainly need to be much more accurate than this. On the flip side, if ak said, “We’re going to have to snow this guy.” (Not really an ak thing to say, but still) I would have no problem with that. As he and I have known each other a few days now, I’m assuming he knows when he says it that I will take the appropriate steps, in a professional and responsible manner as they relate to this specific situation, to sedate the patient to the level that I, or we, feel is appropriate. He’s not giving specific instructions, only making known, or making his agreement clear, that we will follow a certain path of medication that we are both familiar with. See the difference? Anyway, that’s all I’ve got, for what it’s worth. Dwayne

Yeah, man....that's funny as hell right there! Dwayne

Two things... First, I thought this was funny as hell! Second, one of the lessons we've learned here is that jokes aren't appropriate if you don't know your audience. What I found hilarious made ak's fur stand on end! (Yeah, fur, not hair, his line needs a few gazillion more years of evolution before it becomes hair.) So, though I think Spenac is way too freakish in his hatred of practical joke, perhaps this makes his point to a certain extent. On the other had if you were familiar with this crew and knew that they wouldn't freak, then Spenac's opinion and go and pound sand... :wink: So, I guess at this point, after typing this all out, I have to admit that I have no friggin idea what this might have meant... Dwayne

Man, what a special thing this is...There is something amazing to me to find all of the folks that I admire here noticed that I am here as well..thank you all for that. I just thank God that while my beltline is expanding, all of my favorite parts still seem to be in top fighting prime! :-) They did! Unfortunately the younger ones were way cute, but had no skills, and your tried and true favorite found me inadequate...I guess you weren't just bragging about the whole 'pony' thing... Thanks man...though the longer my exposure to you, and perhaps mixed with the addition of birthdays, I'm find at times I'm often pushing the behavioral while waxing philosophical in the closet, so to speak... :-) I'll accept that my friend, in the spirit intended, on the condition that it comes wrapped in the promise of your long and productive participation here. We got started wrong, you and I, but it's Christmas and soon to be a new year, so perhaps we can start again? Thanks for you thoughts and for being here on my birthday. What a gift to wake up to a thread full of the beautiful, smart, sexy, funny, kind people I look forward so much to seeing every day! Thank you all...Merry Christmas! Dwayne

Roger...

In the Springs the jail calls when they have minor wounds or injuries from fights, etc, for a "paramedic clearance" where we go in and make sure it's nothing serious. We can bandage small wounds, transport if we feel it's necessary, or not if we don't. Turns out the dude that attacked this girl tried to hit one of the cops arresting him with a beer bottle and they were offended by that. He was in significant pain, but didn't have, in my opinion, significant injuries, so I left him sit in jail. Dwayne

Ive only had one, but in that instance my goals were very clear... To make sure she didn't have any life threats. To get the history and vitals I needed to care for her properly. To convince her to give a rape kit at the hospital. Sounds cold, but understand that was what I NEEDED to feel that I had done the paramedic's job... What happened is that she became "one of those pts" that I'll never forget. Before I had fulfilled my duties she had cried, touched my face, asked my forgiveness, explained why she was a victim, told me clearly why she deserved it....but before the night was over I was at the jail, inside a cell, doing a paramedic medical clearance on the prick that had given her pain. I don't know how to do the right thing, though I've read the psychology. I just know how to love a damaged patient, give them my full attention and try to make sure that they are safe medically. I started with my agenda, but soon changed to a knowledge that if I could just convince her that she deserved my respect and attention that she would be convinced that she didn't deserve the rest of the shit that happened to her. Yet, I DID fulfill my agenda. Yeah, pretty pathetic. Take your best shot..I can take it. Dwayne

It is because of the bolded comment that I took what follows to mean that you didn't intend it as part of your argument but as a stand alone piece of information, seperate from your stated opinion. And again, it is in the context of the above that I made the referrences to Kaisu as well. Can you show me how I've misunderstood? And could you explain this as well in it's context of this conversation? I'm not tracking. Dwayne

I think the issue that Kaisu is dealing with here is one that you and I have spoken about in the past. You seem to post what you consider general or sometimes specific information on a topic, that people then create opinions from, and respond, but then you reply, "But why are you arguing with me? That is not my opinion, it is simply AN opinion, I have no opinion on this subject." I think it's sometimes the teacher in you coming out, but most of us have a hard time discussing issues with someone that posts information yet has no personal mental investment in the outcome of the discussion. That's where I think Kaisu is getting lost. She seems to be saying, "Ah, Micheal is here to do some mental sparring and exercise." and is attempting to give you the fodder you need to do so, yet your replies seem, to me at least, to say, "Why do you keep addressing me? I have no opinion here, nor interest in any opinions you may have developed, I'm simply adding fuel to a fire that I have no need for." Kaisu's comments make perfect sense to me. You posted some definitions, which to me, combined, and taken with a little dose of common sense, can be construed to mean that you are opposed to practical jokes, as well as believe that they may cause harm. She replied that using that tactic to defend your argument, a not unknown tactic used by many with feeble minds, was beneath you and seemed to assume that you'd done it to be funny, and poked a little fun at you for it. Of course that was not a tactic you were using, as it IS beneath you as well as requires an investment in the conversation to justify it's use. But, having assumed your investment, in error, it was the logical conclusion for her to have drawn. You're reply, and I paraphrase is something like, "But I have no idea what you mean. I have not taken any sides, but simply produced unbiased testimony." Most people argue and debate using their opponents motivations as tools to help to illuminate their own points, or disassemble those of their opponents. When your motivation does not involve resolving the issue at hand, but further thinking about the issue instead, many of us go flying off into the ditch. Anyway..she certainly doesn't need the mental midgets in the crowd to make her points, and as it's likely I came nowhere near any of her intended points anyway, I'll jump back into the wings for now... Dwayne

That's the spirit!

Shoot Ruff, I'm sorry for the hijacked thread, but I actually believe these arguments present some of the best learning for EMS that happens here! I mean, we talk a lot of medicine, and I love that, but it's a rare day that I think "Holy crap! What medicine am I going to use?!" But I'm not sure that a day passes when I don't have to take a minute and think, "How far should I push this?", "What is the best way to resolve this issue?", "What was my part in that conflict and was it necessary or simply lazy and gratuitous?" This is what I see missing in EMS, is the ability to follow an argument to its conclusion. They constantly, mostly by the kids in my experience, end like Kat is trying to end this one by saying, essentially, "You are a poopyhead, so I'm not going to play any more!" That is fine here, God bless him. But that is not an acceptable attitude when your ethically obligated to advocate for your patients. And for those that don't have the skills to go to the mat without getting upset or quitting, where is it better to learn an practice them then here? Tell me you haven’t seen substandard care, or medics that allowed things they shouldn’t simply because they were afraid to step up to the plate. The reason they are scared is the “you are a poopyhead” argument is all that they have in their bag, and yeah, it’s really not all that strong once you get out of grade school. No one has been hurt here. He thinks I'm an idiot, and I often am. He thinks I'm mean and unfair, and I don't believe that I am being so now. No blood no foul man...And I'd much rather have him rail against me here, try his tricks, his tactics, hone his knowledge, and me mine, than have to try and find situations to do so on the street. Or, worse yet, to only have these types of arguments when he has to stand up for his patients. Arguing is a skill…it needs to be practiced. [s:6d74374a17]Maybe we need a category for it.[/s:6d74374a17] I think we need a forum category for it. It is obvious, if you look no farther than the exchanges in this thread that this is a skill that needs to be improved upon. How can we claim to be an educational site when he have the evidence of the need constantly thrust in our faces, yet choose, instead of correcting it, to allow it to be drowned out in cries of, "Stop that! It's stupid!"? (which of course further illuminates the need.) I would hope we could see the value of many of these types of exchanges, as Micheal mentioned elsewhere, and not dismiss or lock them simply because they don't include a drug clac, or they make people uncomfortable. They are important. And besides, don't you have at least a little fun when to committed folks decide to pull each other's hair out? Yeah, ok, maybe it's just me. Dwayne Edited to change lined out sentence and add paragraph in italics.

Yeah Mark, if you come here regularly you'll see that times like now, when things seem to be about personalities instead of information, come and go. There is always a flavor of it of course, but it's not common to see every thread suffering. I think this is necessary though. The information here is valuable, I consider the City a serious educational resource, but it's delivered by personalities, and every now and then the community needs to define how those personalities will interact. Very much like schoolyard rules. What is acceptable behavior? What level of justification should an argument need to meet? How much weight should be given to personal experience, professional experience, posting experience? And on and on. All of these things need to be resolved every now and then..in my experience a few times a year here, as this isn't Wikipedia, a more or less static encyclopedia. It's a sentient, morphing community. That can make it a pain in the ass at times, but also means that you can be exposed to more thought, logic, and valid information here on accident than you can often find on any one subject on purpose elsewhere. I appreciate your comments and hope that you will continue to return. It gets better. It gets worse. But it's always full of valuable information if you're willing to search for it, because like any serious educational tool, you get out of it what you put into it. Thanks for your thoughts. Dwayne