DwayneEMTP

I think EMS is about providing medical care and comfort. Any attempt to purposely retard that mission, or the the faith the public has that that is our only mission will lead only to bad endings I'm thinking. I think if we add an "Am I hear as a medic or a cop?" or "Is s/he here as a medic or a cop?" to health care providers minds, or those of the patients will only be detrimental. It seems to me the government likes this idea because they can gather information in places they can't legally do so now. Unacceptable. I would refuse to participate. Dwayne

You know, I don't think anyone in the world could have sucked at IV's worse than I did. I think in my first ten attempts during hospital clinicals I hit one! They even sent me home on one shift because they wouldn't let me try any more. :shock: I asked for help, begged for criticism. But the feeling seemed to be “you can either do it or you can't.” The only advice I got really was, “Quite being so timid, just stick it!” But I couldn't see how being more 'brute force' and less precise was going to resolve my problems. (It turned out I was mistaken) On my first shift on the ambulance I was nervous as a one legged man in an ass kicking contest. The whole time my preceptor was yelling at me, and I couldn't hit anything! Finally I just got fed up, she was telling me what an idiot I was for taking so long (in different words, but that's an accurate paraphrase) so I just got a general feel for the vein and rammed the cath. And got flash! Taped it down and was good to go. I thanked the God of fools and small children for a miracle, yet tried the same approach on my next IV. Get a general feel for the vein, and go for it without thinking very much, flash! I think in my next forty IVs I missed one and had to re-stick two or three. And several of the successes were on very heavy people where the anatomy was deep and the very mobile (to say the least). Anyway, my point is that for some reason I seemed to just keep getting in my own way. Some part of my little pea brain seems to know how to do this if I just don't over think it. I'm now confident with every start. Maybe this will work for you, maybe not...I just thought I'd throw it out there. Also, I spent a shift in endoscopy. My pharmacology instructor suggested it as the patients all do a cleansing the night before so tend to be a bit dehydrated. The theory being they are a little harder to stick, but you're surrounded by nurses that successfully stick them day in and day out. It was a great experience and very helpful. I'll bet you'll find it will “just come together” all of a sudden. That seems to be a common thread to the 'learning' stories. Good luck! Dwayne

You don't state if the L&S are response or return, that would make a difference to most I think. I did notice that you stated clearly that safety is the major concern. That being said, I'm on board with you. When time is short, and the difference between life and death is a surgeon, getting to difinitive care is important, as long as we always remember that endangering ourselves and/or others is never an acceptable risk. When you can't decide, perhaps ask yourself; Is allowing this person to arrive at the ER 30 soconds sooner a fair trade for the look on my wife's/mom's/girlfriend's face when they tell her I died in a needless crash? Dwayne

Whew...I feel my world slowly shifting back onto it's normal axis. Got it. Unfortunately, in my short time in EMS, I know exactly what you're talking about. I've always felt these discussions were important, but so much more now that I've started my ambulance clinicals. Example, an overheard conversation from a medic to some basics, (WARNING: this will make you cry... Medic: "You know how kemo therapy works right? Basics: "No, not really. Medic: "Well, normal cells are round and smooth, cancer cells, because they are abnormal grow crooked and and get sharp edges. The kemo meds are sticky, so as they circulate through the body, they just sssssslide off of the normal cells, but get stuck in the roughness of the cancer cells, and it kills them!" Basics: "Really? That's cool! I always wondered how that worked!" :shock: So it appears that maple syrup is the cure for cancer? (Then think what a miracle the stuff we used to cut out of Stretch Armstrong would be!) Thanks to all for their thoughts in this thread. I love the questions/answers that make you follow your own logic tree through physiology/pathophysiology! Have a great day all! Dwayne Edit One: To add that little bugged eyed shock thing. Edit Two: To add this to explain my edits.

I think we're all on the same page up to this point... :wink: What about the why? At this point I'm thinking someone has hijacked your computer...Unless this is in jest, I can't imagine this sentence coming from Dustdevil's fingers. The fact that is does not help should certainly be only the beginning of the discussion. I'm thinking someone pee'd in your grape nuts, (or you were being fascecious) or you would have been the first to make that point. And I'm completely lost here... Dwayne

These are my very favorite posts of all. All discussion considered, some research done, and then the a willingness to hang ones hiney out to dry with an independent theory! Way cool. Others do this as well of course, but I've come to give these types of posts the "Fiznat" award in my little brain...for what seems to me to be obvious reasons. And if there is a frostbite issue in snake bites, where there doesn't seem to be in other injuries (not clear on this yet), this seems like as good a theory, or better, than than any others I can think of. Cool thread all in all... Dwayne

Does anyone have more specific info on this? I don't think it's a CORE save at this point by any stretch of the imagination. What rhythm did the medics find? Did they really tell the wife he was 'gone', or is that what she thought their efforts meant? Did they confirm asystole before making that statement? (If they in fact did) By what criteria did we confirm that he was "dead" for seven minutes? The fact that seven minutes elapses between sytem activation and arrival of EMS in no way confirms that he was asystolic for the entire, or even any part of, that time. Etc., etc., and on and on. I'm not saying this isn't a medical miracle. I want a miracle as much as the next person, I'm simply asking you all to be a little more critical before deciding that that is what happened here. Have a great day all! Dwayne

Hell, that was me. I thought the frostbite theory was so far off in the ditch that spenac was just poking the new guy to see if he was paying attention! My apologies to spenac. What confuses me about this theory, is that as a lifetime migraine sufferer, there have been many times that I've fallen asleep with a big back of ice/salt/water on my head (one gallon bag of ice, mixed with salt and water) and wakened hours later with no apparent ill effects. Both brain cells seemed to be intact as well as nothing more than some pain/reddening of the skin. I have heard rumors that this killed some rock star, causing a blood clot in his brain. I'm also sure that it's not a good habit to get into (though I'm guessing that those with migraines will tell you that dying seems like an acceptable risk if pain control seems even remotely possible). So what's up? Has anyone actually seen frostbite from an ice pack? Or even a bucket of ice water? Having lived in northern Minn when I was younger, I had, on several occasions been cold enough to lose the upper layers of skin off of my hands, nose, and ear lobes, yet didn't seem to be in the frostbite arena yet. It's hard to imagine getting anywhere near that level of cold/damage from locally applied ice. I'm certainly not questioning you or your sources Dust (In fact, haven't had time to read them), I'm only questioning the theory for fun based on my own anecdotal/intuitive reasoning. Have a great day all! Dwayne

I will give you 8 trazillion dollars (in small, monthly payments) if you can show any evidence that there is a source for the above info and you didn't simply pull it out of your rear! And if this is the current 'standard', I'm adding some prayer beads and incense to the jump bag. No ice because causing frost bite is more detrimental than snake bites? Does anyone have data on how long it takes to cause permanent damage via frost bite to a significant area of tissue using a cold pack? Just giving you a noogie Spenac. Dwayne

If you assume, as you see on T.V., that most people die from a poisonous snake bite, then the ice makes sense right? The ice will vasoconstrict at the site, containing much of the venom, preventing it from entering the general circulation, saving the patient's life! That is the intuitive, and for ages, the accepted theory. The problem with it is this; very few people die from being bitten by venomous snakes. Many get sick, some very sick, with or without treatment. But very few die. So, let's look at it from this new point of view. A person is bitten. Instead of attempting to limit the circulation of venom, we allow it to circulate. The person is kept calm, the site of injury placed below the heart (if possible), the venom circulates, becoming very dilute, they get ill, then recover without permanent injury or illness. Or, we limit the circulation of venom at the injury site. This causes a high dose of venom to stay localized, limiting the generalized, temporary damage, but doing catastrophic damage locally. The patient survives, only they must now do so without the arm or leg that was effected. We always want to choose 'life over limb', it's just in this case we would be sacrificing the limb when statistically, there was very little risk to their life. Does that make sense? Good question! I'm sorry that asking it in our forum got you a page of jokes instead of the medical info you were looking for, but keep contributing! This is usually a great place to learn. Welcome to the City! Dwayne

Happy birthday lady!

Hmmm...Between you and Anthony...Did I somehow slip into the twilight zone? Taken from another thread maybe? Yikes, the brain shear nearly gave me a seizure...

Great post Wendy. The biggest issue I have with the folks attacking the new members are they tend to be the same attackers over and over, with the same silly posts. The people that won't lock horns with established members, or those they consider more intelligent, so they pick on those that haven't yet learned to defend themselves. It seems to have gotten better of late, but perhaps I have been missing the offending posts. What has worked in the past, and I believe will continue to work, is to simply call those folks out when they do this. Your logic is good! But for those looking for virtual penis extensions by attacking those that can't fight back within the framework that those of us that post regularly work withing (thus allowing themselves to be attacked further), I'm afraid it will have limited effect. I'm sure you've noticed that once people learn the rules, and are no longer easy targets, the harassments stops. Also, we don't need the cooperation of the 15000 members. There are only several dozen, more or less, that post productively and regularly. To those people, that are more interested in learning than bloating their post count...I believe your post will have the desired effect. I'm on board with you on the theory that we need to nurture newer members, for at least their first have a dozen posts. For the most part we are often able to control that with positive posts. But it certainly is time to put up or shut up. Time to expect those that give advice in one or two sentences to become substantive, or just shush. Regurgitating Dust's opinions in reply to the first post of every basic or FF is not advice and I'm just not going to take it any more!! (Yeah, ok...too dramatic...but it felt good to say it.) Anyway, I'm on board with you lady...Good post. Dwayne

Wow, a very mature approach to this problem. My apologies for my assumptions. Once again I'm convinced that your listed age is inaccurate and you're really a 90 year old hippie/psychologist. (meant as a compliment in case the context gets lost outside of my generation) Good job lady. I'm going to 'barrow' your logic tree next time I'm in such a positon... :wink: Dwayne

Yikes, don't I feel like a dope! I was pretty sure I stayed awake through all of cardiology, but somehow I missed this... Thanks all, I'll do some review! Dwayne

Hey all, Had a run the other night during my phase one clinicals. 50is male. AAOx4, somewhat anxious, but in good humor. Chest pain x 1-1.5 hours, radiating to neck and left arm, "pressure" in nature. Nondiaphoretic, possibly a little pale, though not dramatically so. Skin warm and dry. 3 lead shows normal sinus rhythm @ 74 BP 125/85 (ish), pulse full and regular, Temp normal to touch. Patient states stent placement x 2 at unknown locations x 3 years. History of like pain level and location but no MI history. Only meds ASA q a.m., nitro prn. Pt states that pain was 6/10 before he self administered his prescribed nitro s/l 40 mins passed, then 4/10. A second dose 15 mins pre EMS showed no change in pain level. Pt denies n/v, LOC, other symptoms. Addl dose of nitro via EMS shows pain level change to 2/10. 12 lead shows normal sinus @ 68bpm without ectopy of any kind. I mean, it looked like the examples they give you on your first day of cardiology...Perfect. Other interventions performed but unrelated to the question (I believe) My question is this. After the call the medic asked me what I thought was going on. I said "I'm not sure, but it doesn't appear to be an MI." She said "Ok, why?" I said "The perfect 12 lead, nondiaphoretic, - n/v, but mostly because of the 12 lead." In short she said (paraphrased) "I believe he was having an MI and it just hasn't shown up on he 12 lead yet, you do know and MI doesn't necessarily show up right?" Well, I didn't..How can this be? If an EKG shows the electrical activity of the heart, and an MI changes that electrical activity, how can we have those changes without seeing it on the monitor? Maybe a dumb question, but I don't get it. Thanks for any help you can give! Dwayne

You know, I can't give you an answer you'd want to hang your hat on. The set is really not many more pages that the single book, I don't think. We had several other books in the course, but this was the only paramedic specific book. To the best of my knowledge it covers the situations you mention in detail (if detail is used in the context of medic school), but like I said, I haven' really hit the others hard. The times though that I've used them for reference they are nearly word for word. (I actually remember them to be word for word, but I'm not sure, it's been a while since I've compared them) It seems (I know I'm using "seems" a lot, but I just don't remembr for sure) that I stopped comparing the two after about a month or so, because I had reached the conclusion that the set was simply the modules from the one book broken into volumes for the set. I guess I don't really have any solid info for you except that I constantly compare sources on material, and I stopped doing it between these two sources for some reason...I believe it to be because they were so similar. I'm guessing AZ is probably our best resource for this question. Dwayne

I have both. We used the single book for class, I obtained the set so I would be able to reference one against the other. I have read most of the single book, only used the set for reference, and have found very little difference in the items I've compared, most times word for word. Of course I haven't referenced everything, so it's possible there are major differences I simply haven't run across... I'm not sure what the set costs as my intructor gave them to me, but with what I've seen so far, I would stick with the single volume....it seems to be what most schools use. Dwayne

Man, I disagree with the criticism of your questions. I think these are outstanding questions, and that thinking like this is what will make you the master of whatever you choose to do. As always, there's very little to add to Dust's post, and the fact that you recognized that on your own makes you a winner in my book. Follow that advice, take your grades seriously, be a leader. I look forward to seeing your posts on the board! Good luck to you. Dwayne Note: Even at the end of a good post, refering to yourself in the third person makes you look goofy. :wink:

I have little experience, but when I started my ambulance clinicals and my old 15.00 double luman sounded like someone playing "Wipeout" over my BPs and lung sounds I tried the Master Classic. It turns out I had never really heard anything before! Amazing difference. I had a lot of faith in my old scope...because it was green. You know, that's obvious...certainly you could never hear anything worthwhile with a scope with pink lumens..that's just common sense. But I'm quickly falling in love with black. You know what they say.... Dwayne

Yeah, well, you'd have to get in line. And I hear Iraq is wayyyyy back by the end of the line... Thanks for sending her notes Dust...pretty cool. Dwayne

You know, I'm going to take a shot here, with no offense intended. You and I seem to think along the same lines on many things, and I had this situation recently... I'm going to guess your real question isn't "should I be the fink?", because I don't believe you hold to the 5th grade "don't be a tattler", or "brothers don't rat out brothers" nonsense when it comes to academic standards. (You and I don't have any 'brothers' that want to get through school without learning) I'm wondering if your question isn't really "Is doing the right thing, fixing what is an obvious flaw in maintaining the standards in MY school, worth the fallout?" The altruistic answer is certainly "hell yes! Do what's right!" But that's not always real life is it? During my first phase clinicals I witnessed some things that made my blood boil. These things went unreported because I couldn't report them and then still expect to intern in this system. We have to pick our battles, and I can't win these battles as a student. But I won't be a student much longer.... Yet, I noticed in one of my harder biology classes that some of the poorer students suddenly couldn't make it to class on any days of our exams. One day I went to meet with a teacher and while waiting went to the library, and here were all of these 'lesser' students sitting together. I went over to say hi and things got very quiet, until I realized that they were sitting together taking their exam! Books open, freely discussing each answer. No proctor, no supervision, no real concern that they might get caught. I said “Wow...Nice job guys. This one is on me. But you should trust me when I say that next time I see this you will pay a heavy price.” Of course there were threats, and tears, and claims of “I've never done this before”, etc. I then sent an anonymous letter to the superintendent of our branch of the college saying, more or less, “It's common knowledge that cheating is easy here. The next time I become aware of it I will write a letter to the editor of our local paper asking if this is the academic standard we wish to support in our community.” The very next time I went into the library there were cameras in a designated “testing area” with monitors on the desks of each worker and counselor there. One thing I could change, the other I couldn't. Yet. It has made things a bit uncomfortable from people in 'that' crowd, (Mostly 'cold shoulder' crap), but that crowd isn't my crowd anyway. It really has been for the better, for me, and for the school. I guess my point is this. I have a hard time seeing you letting this go. You can do what's right, without torpedoing yourself at the same time. But if you don't leave things better than they were when you found them, what separates you from the 'sheep'? Besides, I owe you a few favors. Keep a list of those that give you grief and I'll drive over and we'll run around school and slap the jello out of the whole lot, all in one day...then go have coffee! Your posts make your intellect and your values clearly evident. There may come a time when it's the right thing to do to back up your peers. Don't get confused and believe these people (person) are your peers. Anyone that's read your posts knows better. Good luck in whatever you decide girl. Dwayne

You all slay me. Something I've learned about myself in this thread... I seem to have a limitless store of language for the posts that irritate me, or seem unproductive, I can even talk a little bit about medicine now, but I don't seem to have any of the language I need to explain how I feel when I read your posts on Alyssa's website. Thank you doesn't work...I say thank you to the box boy at the market, I mean it, just in a different way. I should have something better. I should be smart enough to explain that sometimes I read those posts and I suddenly can't seem to catch my breath. There is something broken when I have a dump truck full of "you're a bonehead" responses, yet nothing 'right' for "You're different. You're attention changes me and everyone around me." I'm going to work on that. Shoot, I'm just an old, fat, struggling medic student. Nothing special here, but some terribly special people give me and my family their time, and sometimes the 'hugeness' of that just comes washing over me...it's a special thing, and if I get hit by a bus today, I wish I had a good way to make sure you knew what that meant. I've gotten some of the most amazing PMs, none of which I've responded to yet, simply because I don't know what to say. I just can't bring myself to send a canned 'thank you', they need and deserves more, I want it to say more, I just have to work on it. Having an MI, spontanious pneumo, get hit by a car? I now have the tools for that. Now I see that I need a better toolbox for this. Thank you for that as well. Anyway. Please know this. You and yours will be in the thoughts, prayers and happy thoughts of my family this holiday season. If ever there is some way I can wash some of what you've given to me back over you or yours...I'd consider it a favor if you'd let me know. Have a great holiday everyone! Dwayne

I'll tell you what, your posts, and the fact that you continue to post, cheer me up and there's nothing wrong with me!!! Pretty cool you do that Kaisu. If you ever need a favor, you come to me first ok? Thanks again. Dwayne

Hi all, I'm giving this thread a little bump, trying to piggy back on some of the good spirit of the holidays! Thanks so much to those of you that have written her...She loves them! And to those of you that continue to write on a regular basis? Man, I don't know what to say to you...that is a different kind of special...Thanks for doing that. Alyssa is doing great! Her Doctor just reviewed her treatments (finding them all to be in order), because she is supposed to be very, very ill at this point in her treatments. But she's not! I believe it's attitude driven. She takes oral kemo daily, with an anti emetic, as well as gets radiation treatments 5 times per week... To date she is pretty sleepy 12 hours out of the day, but almost no n/v, HA, etc...Her hair is falling out in some places, yet growing back in others, which she thinks is terribly funny... She's pretty dang cool all in all. If you have time to drop her a note at the previously linked address...It will be time well spent. Have a great day all! Dwayne