DwayneEMTP

Man, I'm truly shocked by the types of responses shown below. Yours isn't so different FD5, I'm simply picking on it because I know you're a good sport and like a good discussion. Based on what? You've done no lower extremity assessment, you're simply guessing here. If it's my life at stake, I'd prefer you went with an intelligent response based on verified info. Man, I’d like to see you try and explain that to med control. “See doc…I was pretty sure that this huge weight that crushed his legs was controlling the bleeding better than I could, plus, you know, the literature is full scientific data showing the benefits of leaving critically injured people lying on the subfreezing ground…..” At which point I’m guessing he’ll have you restrained and sent for a psych eval… Guys! We’re talking hemorrhage control here! Many of you are condoning leaving a (Possibly!) terribly injured person lay on the freezing ground so you don’t have to contend with bleeding!! The scenario makes it very clear that you CAN in fact do the assessment. You’ve simply chosen not to. And you haven’t assumed the worst here. Next to not having any injuries at all, you’ve assumed the best; Crushed legs with complete hemorrhage control. How far wrong do you have to be for this patient to die? How large of an uncontrolled bleed do you need for this man to bleed to death while you wait for ALS to come and put pressure on it? And how do you explain to his family later that his life was salvageable, but he exsanguinated because the medical professionals on site decided his fate was better left to chance than to their trained/educated efforts? Also, what happens if the chopper can’t make it, or is very delayed? You have no drugs…what are you going to do with the possible acidosis and hyperkalemia when it comes time to remove the weight? Anyway. Most of you know I have no right to be a “know it all.” And that's not my desire... this just seems like such an obvious decision to me. Dust is fond of saying (Something like) “There is only one truly important ALS skill, and that’s assessment.” (My apologies if I got it wrong) Yet most here chose to skip assessment, and wait for help based on their intuition that they already knew what was going on below the weight. That seems crazy to me…but as is often the case…I could be wrong. Have a great day all. I look forward to your thoughts. Dwayne

Actually Doc, wondering about the MAST pants is what got me to thinking, "Based on what?" We haven't moved the block, there's no assessment completed....shoot. We've got all of these great ideas based on worst case scenarios, when in fact, based on my limited experience to date, that is almost never the case. Much more often I look at the MOI, see "Mr. Should Be Dead" laughing and dancing around, and think, "That is the luckiest bastard on the planet right there!" :shock: Anyway...was this a real call? I don't remember now...But I think most of us made too many decisions with no information...this was a great learning question. Dwayne

But BLS treatment for shock is to elevate feet, keep warm, O2 right? How are you going to do these things? I also say he has to go. It's too cold to stay and dink around, as well as the fact that you might as well be driving in case the helo doesn't show up. Also, the "stay" crowd seems to be assuming that because his legs are crushed (how do we know? They might not even be broken.), that all bleeding has also been controlled? What leads you to that conclusion? I'm not saying it's impossible, but you've bet this man's life of a fact that you have chosen not to verify. He may be bleeding, he is certainly going to freeze to death (No way you can heat the ground under him), it's time to make the hard decisions folks. This is what you've trained for, practiced for....Go to work! Get him out. I can't decide what's killing him if I can't assess him. Get him naked. With 4000# on his legs, do you suppose he might also be injured elswhere? Get his life threats under control. Elevate his legs, pressure on bleeding areas, if necessary we're going to use tourniquettes to stop the bleeding. Hell, they might have stopped, if they had in fact ever started, by the time you get him out. Get him warm while you're driving. You can't assume that because something big and scary is on his legs that you have to wait for the "oh shit!" people. On this scene you are the oh shit people. So for those of you that chose to leave him based on your worst case scenario... You wait an hour for ALS to arrive by helicopter. By this time your patient is a trauma code. ALS ceases attempts at resuscitation. After removing the object you discover that the sandy loam below the man obsorbed most of the weight of the falling object, but a large bolt sheared off his left foot. The uncontrolled bleeding combined with the sub-zero ground temp. caused the pt to die while you waited for "someone else" to do something. All he really needed was the elevation and pressure that could have been offered by a first week basic and he might have lived for days.... Just sayin.... Dwayne

It sounds like you tried to talk to her while she was at your facility. You don't owe her anything else. Burn her down if you can. Dwayne

I think someone was blowing smoke up your hahoo trying to look smarter than perhaps they really are. After the break you might have some muscle damage from sharp bone ends, all of which will be permanent. Histamine release, vein/capillary leakage into the tissues causing the swelling, clotting cascade...etc. Other than the direct physical damage done by the bone and the forces involved in breaking the bone, I'm not seeing the chemical reaction that might be stopped to save muscle....But of course I never see everything. Lack of circulation can cause secondary tissue damage if not corrected...and some of that might be done by cooling the area, but again, that is a physical intervention not chemical. Nope. Can't think of a chemical reaction that might be applied to this situation. Dwayne

So you've had enough, so what? Dust has made some logical arguments. Time and time again he's challenged you to express yours in an intelligent, logical manner. You have still failed to do so. I often look forward to your posts, but these silly, "I'm so dang mad I just have to say something", 5th grade rants certainly don't fall into that catergory. Dust says the same things over and over...consistantly validating his points with proof when possible, strong logic at the least. You coming in here and kicking and screaming simply reinforced his point that "your" side has no valid arguments, can't you see that? Good luck with your new tact....I for one hope the tantrums won't last and you'll someday go back to the quality logic, if expressed in single paragraphs, that we've come to expect from you.... Dwayne

Yeah...I think so. :wink: (I didn't see the movie, but heard it was great!)

Yikes, I'm kind of suprised by some of the responses. Some of us are old enough that we believe that when you benefit from something, you give something back. When I can, I send money, when I can't I try to be productive in the forums. When I'm really feeling like a slacker I prowl for, and welcome the new users to the site. This place can be an amazing resource, one that you can't easily replace with a book, video, or even a classroom. If you've gained from it, perhaps it will make you feel better to try and give something back to make it grow...make it better. If you have no desire to repay some of what you've been given, then you'll never understand the reason for Capt's post, should ignore it and go about your business... I think he was simply suggesting that you "Pass it on" when/where you can. Dwayne

What I find even goofier that transporting all codes? When folks decide that because "someone" does it this way then this is the "American" way. I can tell you it's not the Colorado Springs way. (20 mins ACLS then cease with medcon approval if possible, without approval if not.) Do you simply have one blanket set of protocols for Canada? Everyone does everything the same way...everyplace? If not, what has caused you to believe that that is how it works here? I swear, if I said "And I poked him in the eye with a 14g needle to check responsivenes." Someone would say "Really! That's how you do it in America? Anyone else do it the American way?" Protocols vary here... Just sayin'.... Dwayne

For National Registry? Basic, Intermediate, Paramedic? We're going to need a little more info I'm afraid. Dwayne

Good for you Kristina. What was their beef with the classes you were taking? Any idea?

Say FD5, I'm still pretty new at this.... But how do you give "2-4mg MS"? :wink: Do you have to use one of those new fangled variable dilivery syringes? Sorry Doc, I don't have any good "Oh hell!" stories, so I was having a little fun at your expense... Dwayne

Good God people....It's a silly question in the "funny stuff" forums..Exactly where it belongs! Lighten up, don't read it, don't answer it, but take a friggin chill pill already.....Plus I think it's hilarious that each of you that complained about this post did so with horrid spelling, grammar, punctuation, capitalization, etc. You found this post below YOUR standards! Give me a break. And yeah, I always close the bathroom door. Friends and family come and go as they please at our house...and I like my privacy! Dwayne

That was interesting. He said he thought it was secondary to acid reflux. I told him no heartburn, no sore throat, etc, etc. Anyway, he put me on a trial of (I can't rememeber. That antacid pill that's on the TV every other commercial?) acid reducer and sure enough it hasn't reoccured. Dwayne

Off the top of my head I'm going to guess laryngospasm. I dealt with this a few months ago. Throat felt tight, I was starved for air, heart rate up into the 140s. It was the strangest thing because I could feel my lungs filling, I knew for a fact that when they put a pulse ox on me it would read high 90s at least, but still felt like I was suffocating. I controlled my breathing, so no hyperventilation. It would last about two minutes or so...scared the bejeezus out of me! Then I'd be fine for a few minutes, and then it would repeat. 0.5mg of glucagon at the ER and it soon resolved. Dwayne

Thanks WANTYNU. But it's mostly time, these most recent posts I mean, spent between us. Like another well know instigator here, Captain will almost certainly not be back to this discussion. He loves to rant and rave...but doesn't have the gnads to back up these kinds of statements if challenged. It is refreshing to see that most don't subscribe to the "Let's keep doing what we've always done even though it's been thoroughly proven not to work" ideals. Perhaps there are answers in the future after all. Dwayne

Yeah, I'd be up for it. I have a pretty small window though...I'd have to know the date before committing. Dwayne

I'm looking for honest opinions here, not the easy opinions. You'll see what I mean... Called for a stabbing the other night. Arrive on scene to find approx. 300 people drunk and going nuts. The cops (about 5 or so) are in a semicircle around a girl that is completely covered with blood from her hairline down to her jeans. Cops are pepper spraying the crowd to keep them back. A dozen people writhing on the ground from being sprayed.(The girl is near the entrance to the club, so it’s difficult to tell if they are trying to keep them back from the club, or from the girl) Do you go to the girl or not? I’ve come to understand, to my surprise I might add, that I don’t have what it takes to wait for the crowd to be controlled before I help the girl stabbed in the face. Am I going to take a beating here? Yeah, I’m guessing so. But I’ve been gifted with these tools of medicine, and I couldn’t sit and watch her bleed while I did nothing. This was my decision, my preceptor left it to me, I expected to get my ass kicked afterwards if I chose to go…I just couldn’t do wait. And my preceptor wouldn't have waited either. God bless her for giving me the learning opportunity...but I would have waited by myself in the ambulance. Enroute to the hospital she goes into shock, begins having seizures. Fluid, heat, diazepam, and all ends well. Would she have been worse off had we waited half an hour…probably not. Maybe so. I don’t know. Called for a mentally retarded girl. Violent and dangerous. Upon arrival we see her attack her caregiver (pushed her down). The medic (5’ and a little bit) says “Hey now! Easy…..” and goes up to the 40 something year old girl. The girl puts out her arms, as the medic goes towards her I think “NO! She could hit you!” or “ Scratch you!” or whatever…But the damaged girl engulfs the medic in her arms and cries…and cries…It is an amazing, inspiring, and completely inappropriate moment from an EMS point of view. I would do it again in a second. So is EMS safety absolute? Should Dust be considered less of a medic because he's chosen to work in a war zone? It’s not safe…he knows better…be could become a victim…See what I mean? Your thoughts/experiences? Dwayne To the basics out there. I'm 44 years old. I've been down a road or two. Until you've developed your own sense of safety, and what you're willing to be injured for, you will be considered idiotic, and rightfully so, if you endanger your safety for the safety of others...I'm just sayin'...

Man, you may not have much experience, but that is everything that I would hope would run through the mind of someone working on my son...Pretty cool. If you can do all that...I'll thank you and enter the worst time of my life knowing that someone intelligent, competent, and caring has done all they could...But there simply wasn't enough to do. Ditto above. Great post. Also, we can cease medical intervention in the field with Med Control approval on medical/trauma arrests. (of course I'm preceptoring, but have seen the scenario several times). I believe the odds of ROSC later is nill, and it is certainly best for the family. Can anyone truly watch CPR and hold out high hopes their loved ones are going to be ok? Great post MM...inspiring. Dwayne

You know Cap, when you discuss medicine, you can be inspiring. When you discuss anything else you mostly come off as a dumb redneck. Disagree with an opinion? State so clearly. The above response to an intelligent post is straight off of the Jeff Foxworthy’s “How to look like an inbred hick” list of 20 ways to look like a ‘Smart Feller’. The problem is you only look smart as long as you’re careful to stay within your own little community of redneck ignorance. Your way? “Doing the same idiotic thing (prison) over and over because it makes me FEEL GOOD, so it must be right! Let’s all us good ol’ boys ignore the fact that it fails nearly 90% of the time! YeeeeeHaaaaaa.” If you practice medicine the same way you consider societal reform then you’re the biggest poser on this site… Idiotic. But it does allow you to be lazy and simply spew the same old tired line of “Look at me! Isn’t my disregard to intelligent thought and human life just macho as hell!” Do us all a favor. Take a psych class. Learn how people and societies work and give all this crap a rest. No one over the age of 18, (at least without a shaved head) that truly wants to resolve these problems before their kids have to deal with them, is jumping on board with nonsense. And should this happen…shouldn’t we start with your house? I mean, you’re the one trumpeting murder, prison, and uneducated macho crap. Wouldn’t it make sense to start there so we are left with those that want to take an educated approach to resolving some very dire issues as opposed to the emotional emesis that has been failing for centuries? B.F. Skinner, a gazillion years ago talked about the 'Autonomous man theory'. He claimed that "good" people would never allow for the fact the 'nurture' played a part in people being 'bad', thus not completely at fault and for their behavior and therby fixable, because they would then have to admit that they were not completely responsible for being 'good'. You are the embodiment of the ignorance he was predicting. Read a book. Take a class. Quit looking silly in these discussions. Dwayne

You know, I've only seen one person put and IV into an artery. An old man, veins like ropes all over his arms. I can see how you can possibly hit the artery, but how do you not know after? There was blood all over the floor, as the medic student believed he wasn't occluding properly, but when the line was attached, the blood ran back into the bag that was hanging about 3' above the patient....Even I knew that seemed a little hinky! Does this really happen that often? Dwayne

:shock: Hasn't it been about nothing else for the last 4-5 pages? Dwayne

56 y/o male, difficulty breathing, history of asthma. Continuous albuterol neb during 15 min transport without checking lung sounds. (No, not my patient) Actual condition? Undiagnosed CHF with ( I can't remember the location) STEMI. Nuff said? Dwayne

I sometimes share Anthony’s point of view. Mostly, for example the way sexy 18 y/o girl that was out clubbing with very few clothes on and got in the fender bender...I want to be thorough, but am not yet comfortable with how much is enough... And with my inexperience (about 350 pre-hospital patients so far) I have to wonder... if, after brining in 50 cute bicyclists without their sweaters, and without bullet holes, if you're going to have your medic ticket long enough to ever find the one patient with the bullet hole? Do you know what I mean? I've found that most exams can be done by moving clothes around, but that still doesn't eliminate the need for the ability to defend being under them in the first place... I think for many of us new to the field, and with so many pervs on the news, there is going to be a tendency to feel hinky when getting under people's clothes, (Not so much with the less attractive it seems. Not because they are less valuable, but because perhaps we feel they wont be looking as hard for ulterior motives?) until we've done it enough to be able to defend our decision to others when the need to do so wasn't immediately obvious. Don't misunderstand. Felling 'hinky' is certainly not synonymous with becoming mentally/professionally impotent in these situations. It won't effect my decision to deliver the best care I'm capable of. But I think that this might not always be the case for others though...which is why I feel the question is important. The further I go in my education, the more I find that good medicine isn't mandatory, but is noticed by other's that take medicine seriously. But even good medicine isn't the complete picture..You need to keep your eye on the monitor and your drip rate while keeping politics, innuendo, and the perceptions/biases from associated disciplines firmly in your peripheral vision. Dwayne

So it's your opinion that if there are holes in the old testament that NO deities exist? Yikes, the Budhists will be sorry to hear that....Pretty weak argument DBS. And has nothing to do with the post you quoted, at least that I can find... Dwayne