DwayneEMTP

I'm guessing when she says 'intubate' she's referring to rescue airways... I can't even fathom the system that will let basics place an ETT but not start an IV... Dwayne

Mobey, I love your posts man. Don't always have to be right, fine with being wrong if you can learn from it...That's pretty smart, and pretty brave. A quick thought on your question. I'm thinking we have a systolic b/p of 80 now. We currently believe it takes between 80-90 mmHg to perfuse the brain, so we're already treading water in that respect. Let's say it takes 30 mmHg of pressure to stem the flow of blood for this wound (just pulled that out of my rear). Have we then reduced the pressure for cranial perfusion to 50 mmHg or so? I'm not sure if it would do so or not...perhaps after the the pressure built up behind the occlusion the original pressure would be returned more or less? I'm not sure, physics is on my list to take after I'm done with class. But let's take it a step further. If we must monitor our interventions, how would we decide if we had created this pressure differential or not? We can't base it on cranial b/p (well, could we do so with MAT calcs after we've added the artificial occlusion?), can't monitor it based on LOC as our patient is unresponsive. So based strictly on the assumption that we can't verify effectiveness, nor monitor the intervention for creating a negative outcome, would we choose not to use it on these criteria alone? Plus, if we have the hands available, do we want to attempt to explain to those down the line our choice to apply a band around the neck even if WE KNEW FOR CERTAIN that it wouldn't increase morbidity/mortality? Like you, I don't know for sure...just thinking out loud... Dwayne

I don't believe this was started as a health contest. The question seems to be can you "appear" professional and be fat? I'm guessing he's referring to the public perception as well as that of the the other health care professions. I believe it's very difficult. On my clinicals I've worked with a basic that is pretty overweight, yet is the pure definition of professional. Always well groomed, very intelligent, very competent at her basic duties, and is respected by those she works with, doctors, nurses and patients. But I believe it's because she regularly does everything right. Her appearance, demenor, posture, grammar, etc. There is a paramedic I've seen that would fit the same description. The rest? They simply appear to be slobs to me. Stink of smoke, shirt untucked, unshaved, hair uncombed, belly hanging over your belt? Any of these, I think slob. Understand, I'm 6' 230lbs. When I look in the mirror I see a cow...but losing the weight takes effort and committment, of which my available stores are spread pretty thin at the moment. So I'm not making a rational judgement of these other folks, simply giving my knee jerk reaction first impression of them. I'm also completely aware of the fact that I must negate my appearance with superior behavior if I'm to show those whos opinions I respect that I am more than I appear to be at first blush. It actually works for me at the moment, because I wish to learn to be more than I appear to be at first blush. I believe the flip side to be true as well. Show up well groomed, well muscled, clean, smelling sweet as a spring day? People will believe you're professional even if you're a complete knuckle head. Temporarily. For those of us that have weight to lose, need to quit smoking, should shower more regularly and feel we shouldn't be judged by our appearance? Welcome to the real world. If you want the respect given by default to those with a more conservative appearance , play the game. If it's not worth the effort, then walk the path you've chosen. For me personally? If you show confidence, competence, self respect and compassion...Most everything else becomes invisible anyway... Dwayne Note: First edit for spelling. Second edit because I forgot to explain my first edit. :oops:

How much blood does there appear to be? What does the pt's skin look like? How big are the bubbles coming from the wound? We may be jumping the gun a bit with arguing the type of dressing if this man's larynx is involved. Rapid transport is a no brainer, stopping the bleeding is a no brainer, but if there are large bubbles coming from his larynx upon expiration, what do you suppose is happening upon inspiration? I need to see the location/anatomy involved in the injury, but at this point it sounds as if I'm going to intubate at the same time they are putting him on the board. ABCs. With the above description it sounds as if A/B could be in serious jeopordy, I believe I'll address those while someone gets a couple of good IVs and fire is packaging for transport. What was it we learned in Basic class about delivering a well bandaged/splinted corpse? And I'm not on board with the ACE bandage...I'm thinking a full diameter pressure dressing is a bad idea in a neck injury. We're going to have someone bagging on the way in, they or someone else can manage the wound manually (certainly an occlusive dressing, regardless of what we decide to use for bulk outside of it), unless we have a 3 hour transport or the like... More when we get further informtion. Dwayne

Hey! I recognize you again in this post! Welcome back. I don't think we're talking apples to apples on this topic. Do you run all medic/basic trucks NR? If so, I don't see the issue either. All of the basics here start IVs...as you've said, it aint exactly rocket science. When this comes up I think most of us start thinking unsupervised basics with access to fluid therapy. As was mentioned before, it's uncommon in my limited experience to start an IV on someone that isn't pretty dang sick. And if they are really sick, I'm not trusting anyone with the management of my fluids. Fluids are really pretty dangerous to many people. Also, I don't think many of us think supervised basics are "to dumb" to start an IV, it's simply a slippery slope. From your past posting history (the last few weeks excluded) it seems obvious to me your intelligent, committed, and as capable as any basic out there. But my experience has shown me that you are the exception, not the rule. Unfortunately we must argue based on the rule. It does hurt my heart a little bit to hear you make the "every marine can do it" argument, as I believe you to be smarter than that. In all honesty, how many well conditioned 20 y/o patients are you going to run on next month that are going to need fluids? Yeah, not many. It's pretty hard to screw up fluids in this group, far from impossible, just much more difficult. If the average marine was likely to be 60-100 years old, suffer from CHF, MI, renal disease, or dozens of other health issues...then I'd take this away from them as well. I'd like to see us all get back on the same page. As a 'near' medic, I don't have issues with basics starting IVs because it makes me feel less important. It is a very dangerous, though at times very beneficial skill. When done with the aid of someone versed in A&P and common disease processes, I don't see the problem. It's not the IV start many of us are arguing against, it's the incorrect use of fluid that makes me wary. Dwayne

Man NREMT-Basic, you used to have some great posts... I'm sorry to see you turn into an angry, illogical, one dimensional baby. I'll miss your intelligence here. Dwayne

Will do FD5. It was nice of you to do that! Thanks... Dwayne

Just curious. Why do you create a post that says you have no comment? Wouldn't not leaving a comment be better for the thread, and say the same thing? Just wondering.... Dwayne

I had deep fried Twinkies and Orios at the carnival last year... If the carnival was here year round I'd have to nickname that 500 pounder Tiny. They are hard core yummy... I'm just sayin'.... Dwayne

I've long thought that punitive damages should go to charity. You get your $5 million dollar settlement, go home with the $100,000 needed to repair your scraped knee, and cancer research gets a much needed $4.9 million dollar payday. No one is encouraged to sue frivalously, rich people/entities get punished based on an amount necessary to sting them a bit, and we all get to feel better for it at the end of the day.... No...no need to thank me. Solving the world's problems in a few paragraphs is just a hobby of mine.... Dwayne

And how do you justify $5 million? Lost wages? Loss of sexual satisfaction? "They have stolen my dream to be a ballet dancer!?" Maybe he'll get his money, but it should be paid out in installments...to end at the time of his death. That should cost the city about $300,000.00 or so.... Dwayne

For some reason this piqued my curiosity hard. I'd love to hear whatever you can find out. I'm not going to research it until I hear more...see what we can figure out with the information we have in our brains so far... Thanks Kaisu.. Dwayne

I never intended to imply that you did. I was hinting that I'd like you to justify your feeling that she was in trouble. Were more or less the entries I was referencing when speaking about the bitching...not a big deal. It simply seemed that the thread was going in a direction that wasn't all that positive...I wanted to hear more about this patient and didn't want to miss out on the opportunity in the case that Kaisu didn't want to contend with the attitudes. What students were offended? I can't think where Kaisu referenced being offended by anyone. I took exception to the tone...made my point...and now am going to move on. If you reread your responses to her posts and feel that they were sincerly intended to share this educational experience with Kaisu and the rest of us, then I apologize if I've offended you. There. Now hopefully we're all adequately consoled and can get back to learning what the heck was going on here. Until this thread I'd never heard the term 'narcotic induced pulmonary edema', but now that it's in my head I'd like to find a place to put it. I hope all is well with everyone, life is treating you great, and look forward to a gazillion more spirited discussions in the future! :wink: Dwayne

You made it clear you didn't care about the part of the scenario she found interesting, even though chbare, one of the smartest people on the City, thought it was relevant. And then have the gnads to be offended she didn't answer your other questions? You got the response you deserved. You know, I'm just a dumb ol' medic student...but I'm trying to see what criteria you've used to decide this patient is in big trouble? Does it sound like she's having an issue...sure. Is it time to throw the entire hospital at her...I don't see it. She could have bronchitis, have aspirated her jello, been gargling with salt water...We don't really know yet do we? Yeah, seems pretty hinky doesn't it. Lighten up man...Ask good questions with some respect and you'll get good answers. I know...I've asked her a million of them... Did you get lung sounds on this woman Kaisu? Is it possible you were hearing rhonchi instead of rales? Cool case...I'd like to hear more about her presentation...We can PM if you'd prefer to avoid all of the bitching in this thread.... Dwayne

I am addicted to this site! http://ecg.bidmc.harvard.edu/maven/mavenmain.asp Dwayne

The sentence in bold is an outstanding example of why this entire idea is bad. In this thread I've seen several examples of "Well, at least we can give glucagon!" Terrible idea...which I'm not going to explain here....If you're curious, do some research on glucagon. Then look to see who has stated the above opinion, and from now on understand that they are far too ignorant of even the the most basic understanding of physiology/pharmacology to be caring for patients without direct supervision...much less looking to expand their scope of practice. You don't have to believe me that it's a bad idea. Do the research. Look to see how many are ignorant of that research. Then decide if you want those same people caring for your family members. It's that easy. Dwayne

I agree with all above. It's one of the only "certs" that gets into the meat and patatos and then makes you funnel the knowledge from your brain into your hands. Very much time well spent. Dwayne

Not being sarcastic...but short of putting a rope around his neck and dragging him out with the ambulance, how could it have been worse? They put on a C-collar and then had him crawl out on his own. Now, I'm a believer that we spinal way too many people...but if you're going to put all that uncomfortable crap on a patient, at least make the effort to allow it to have some value... Just my thoughts... Dwayne

+5...The original post was frustrated and angry, for very good reason, yet the thread continues with lessons learned, personal responsibility taken, and ideas for eliminating like issues in the future. Are you SURE you work in an LTC? Just a fair warning...should you insist on continuing with this type of behavior, and it should by accident spread, to other facilities and EMS...well, hell, in a year or so we will run out of reasons to hate each other...Completely unacceptable! :wink: I hate nursing homes (by any name) but have a feeling I would like working with you just fine. Thanks for the great posts, and showing us all that we can change things for the better if we attempt to eliminate our own faults first. Your post reminds me that I've been frustrated and angry about nursing home calls...yet haven't posited a single theory for resolving the issues I have (if burning them down doesn't count). It reminds me that I've become part of the problem. I'll pay better attention in the future to becoming part of the solution. Dwayne

Man, this is like being in a Monty Python skit…. Medic 1: “So we’ll need to lift the weight and see what’s wrong.” Medic 2 “Well that would be silly, now wouldn’t it?” Medic 1: “Why is that?” Medic 2: “Why waste valuable time when we already think we know what’s probably wrong.” Medic 1: “But we don’t really know what’s wrong, right? We’re just guessing?” Medic 2: “But our guess must have been right.” Medic 1: “But how can we know it’s right? Medic 2: “Because we’ve used it to develop a diagnosis. Certainly you wouldn’t do that with a wrong guess, now would you?” Guy Under The Weight: “But I don’t Liiiikkkkeeeeee guessing. Besides…I’m feeling better now….” And on and on until someone decides that adding additional weight is what’s best here…. Dwayne

But very often it does. Ignorant is not synonymous with 'stupid' for most of us. Ignorant Ig"no*rant, a. [F., fr. L. ignorans, -antis, p. pr. of ignorare to be ignorant. See Ignore.] 1. Destitute of knowledge; uninstructed or uninformed; untaught; unenlightened. He that doth not know those things which are of use for him to know, is but an ignorant man, whatever he may know besides. --Tillotson. 2. Unacquainted with; unconscious or unaware; -- used with of. Ignorant of guilt, I fear not shame. --Dryden. 3. Unknown; undiscovered. [Obs.] Ignorant concealment. --Shak. Alas, what ignorant sin have I committed? --Shak. 4. Resulting from ignorance; foolish; silly. His shipping, Poor ignorant baubles! -- on our terrible seas, Like eggshells moved. --Shak. The subjects and material of which I'm ignorant are endless...but I'm picking away at it.. Dwayne

http://www.fda.gov/bbs/topics/NEWS/2008/NEW01788.html FDA: Chantix's Link to Neuropsychiatric Complications 'Increasingly Likely' The FDA has issued a public health advisory on Chantix (varenicline), saying, "it appears increasingly likely that there may be an association between Chantix and serious neuropsychiatric symptoms." The smoking-cessation drug, still under review by the agency, may have additional warnings added to its labeling. The FDA announcement emphasized the following: Before starting Chantix, patients should inform their clinicians about any history of psychiatric illness. Providers, patients, and their families should monitor for mood and behavioral changes during and after Chantix treatment.

What I'm getting at is this. If you can't assess without lifting the object, you must lift the object. If you can assess the feet without lifting the object then one of two things is extremely likely; One: You find you don't have pulses in the feet, so you have to lift the object to see if you can restore them, right? Two: You have pulses in the feet, meaning that more than likely the legs aren't completely crushed, so you must lift the object to assess for further, possibly life threatening, injuries as well as high tail it to the hospital, right? I'm just having a hard time understanding what you're going to find in your assessment that is going to convince you that leaving the weight in place is a sound medical decision in this case... Surely somewhere in your protocols it suggests that you assess your patients before making life or death decisions concerning their care? How can you possibly defend leaving this man to freeze based on your GUESS that he might bleed if you free him? Then you certainly shouldn't give the next seizure diazapam, as there is a risk of anaphylaxis and/or cardiopulmonary arrest. I'll tell you this...I'd rather castrate myself with a dull spoon than go to this man's family, or med control and say, "You know, I thought about moving the weight, but was afraid he might bleed and I wouldn't know what to do!!" Controlling hemorrhage is week one of basic class....you guys are breaking my heart by deciding to leave him on the ground because you feel the weight is controlling his bleeding...That's crazy... We're educated/trained to help people and deliver them to the care they need...not create pie in the sky diagnosis based on urban legends* instead of sound medical principles. No offense intended to anyone. It’s just that the further I go in my studies, and the more people I put my hands on, the more I realize that we’ve been given this amazing ability to change the outcomes for a small percentage of them…to watch you allow a lesser, possibly fatal outcome, based on a GUESS of what might be going on, while you stand and watch this man die simply knocks my world out of balance…. Fun discussion. I truly would like to see someone support the idea that leaving this man crushed and freezing would be viewed favorably by the general medical community. Have a great day all. Dwayne *The urban legend I’m speaking of is the man who got trapped by a truck/train/subway car/statue (depending on the version of the story) and the powers that be decided he was not salvageable, at which point they brought him food and drink, he talked to his loved ones on the phone…had a grand ol’ time for a few hours, until they released him, at which point he died instantly.

Welcome. Good spelling, punctuation and capitalization are appreciated. As well as proof reading before posting....I have no idea what the above sentence means. As well, we're going to need a good, straight question. And I'm not sure what you mean by privately? At home? Online? Many here will be happy to help once we understand the question.... :wink: Dwayne You're welcome

Ok...I give up.... Dwayne