DwayneEMTP

Yeah, I get that, I meant before her death. It could be argued that going into space twice was not even the the pinnacle of her professional achievements, nor, as Annie mentioned, as a human being. She led an entire life that was inspiring, and worth being celebrated.

Shit.. I need to think for a minute....

Hey Kyle, good to see you back! And thanks for revisiting this thread! It does my heart good to see you do that. I once went and revisited some of my old threads, but it was too painful. I was even more idiotic then than I am now, only I had NO clue then....But, it's good to see the changes, right?

Man, I don't know.... I'm not even completely sure where a person would start looking? I used to just putting such things here and having someone answer them.... :-)

We certainly agree that shock is relevant and diagnosed based on more than a b/p. I tried to be clear about that in my postings. DFIB, I see your point and agree. I'm not sure that I've ever looked at a patient and thought, "Hell, they've decompensated." But instead felt that they were compensating, or decompensating (within the context of the discussion). In my mind they are either compensating for things that I can detect that I feel would need to be compensated for, meaning that they are not presenting the clinical picture that I expect based on assessment...The left, level and then upslope side of the graph... Or the compensation had occurred and was slowly/quickly failing, the right, downslope side of the graph beginning from the peak compensation/compensation failure point.. I guess I've always just called the decompensated right side level ground, "Oh shit." Thanks for your input...And Chbare, yeah, this seems like an awesome time for you to step in when you have time...

As above DFIB, what would cause you to believe that this child is compensating instead of decompensating? Unless of course the entire sentence was part of your pun, in which case...shame on you! It was terrible! (But I did get it...)

I went on a standby in Colorado for a type of motorcycle racing that, I don't remember what it's called, but the track is say, 7-8 miles long around back country and they do a certain number of laps. Pretty cool, lots of endurance, rough country... But they had two 'medics' that traveled with them to provide first aid care. Both EMTBs, they had no medical direction, traveled all over the country, and the only reason that they had a standby ambulance was that the property owner demanded it. It does seem like it could be a niche...I'm not sure why you would need medical direction for first aid, but I wonder if having a professional cert would remove that option from you? One of those things where it's ok for a non trained person to provide it, but a trained person needs oversight?

It seems like there have been several threads lately thrashing those that want to do independent standbys...I don't know of course, but my guess would be that that is where he is coming from... I've been curious about this lately...at what level I wonder do you need a medical director if you're offing minor first aid only?

You might be right about that, though I'm not sure how much rate figures into the equation. Maybe a lot, but I don't know. And my thought, if we were going to define this condition as shock, which I'm not sure is accurate at this point, would be decompensated, as her pressure should be more elevated if she was still compensating, right? I'm a little bit surprised that I'm the only one making the argument for her blood pressure not being elevated. If we expect, based on her condition, for her blood pressure to be significantly elevated, yet instead find her to be normotensive, then that would actually be a relative hypotension, wouldn't it? I think that my thinking is much less sophisticated than yours. For me the elevated heart rate, plus the elevated respiration rate, can't possibly, in my experience be associated with a calm patient and in fact I'm confident is going to be associated with a patient that freaking out. This freaking out is going to cause a catecholamine release, one of the effects of this release is going to be vascular constriction, which, in my little mind should lead to an increase in blood pressure. When I don't see this increase in blood pressure then I assume that something is retarding it. In my experience that 'something' is going to be either physiological, or pharmaceutical. So I immediately begin looking to solve one of those problems, or both, with further investigation. Of course there's always the chance that unusually low b/p is normal for her. But those aren't really very good odds to play in a patient this severe. So if I assume that this 6 year old isn't likely on any type of pressure controlling meds, then an allergic reaction, in the context of this made up scenario, makes more sense to me than an asthma attack. See? Like I said, not terribly sophisticated thinking. Many here, like you likely, could go into it in much more depth and probably use many calculations, but that's what I've got Brother.... Thanks for your response!

Never doubted it Brother! Hey, take this chance, in this new culture, to up your game, ok? Good on you...

In Kabul, or BAF? What kind of money? If it's not $100k or above, then you're probably going to a dump...

Man, it will be interesting to see how this plays out. The problem is that a diagnosis of rib pain followed by a fatal heart attack doesn't mean a misdiagnosis. It's sure looks like it though. And they're asses are going to be hanging out for not transporting.

And I'm going to play Angel's advocate, (I mean, the devil was already taken.) (Stop laughing DFIB, it's not that friggin' funny.) First, I really hate these formulas (No disrespect intended, just my opinion) as they seem to have been designed for certain age categories, within certain weight ranges, under certain conditions. I did them in my head as a medic student but just couldn't make them jibe with real life and abandoned them. But lets say that they are accurate. Your formula says that 102/s is normotensive for this child, but I'm assuming that that value is at rest. She's now slightly below that, which could also be her normal baseline, she's got a resp rate of 40 and a pulse rate of 140 so there's no question that this Babe is in severe distress, right? What is happening to all of the catecholamines that this distress will cause to circulate? How is a baseline normotensive finding a good thing in this patient? I don't believe that it is. My guesss would be that the vasodilation secondary to the allergic reaction is keeping the b/p from elevating. Did we get lung sounds at some point? It actually sounds like an anxiety attack, but again, we'd have to explain the lack of an elevated blood pressure secondary to her extreme anxiety to make that argument. Unless it's your feeling that this child's normal B/P in the 70's/s or so?

See! I knew this was going to be awesome!!

You know what Brother? With a degree in biologic sciences you'll be so far ahead of the medics that you work with normally that it will be ridiculous. Because of being a member here I dropped out of a 7 month program and got an AAS in paramedic medicine and it's rarely done anything for me, where others are concerned, but piss people off. As a medic it's made all the difference in the world. Trust me on this. Someday you'll be sitting in a room of, say, ten medics and you'll all be talking about school and you'll mention your degree....two of them will go, "Right on! I wish I would have done that!" and the other eight will look at you like you just grew a vagina on your forehead. Why? Because those eight know the truth...that being a paramedic is about blood and mashing ribs...all of that silly book learnin' just gets in the way. In my mind? You're a degreed paramedic +5, for what that's worth. But you'll find that to be an uncommon feeling outside of EMTCity. Also, if an employer asks about your degree it's unlikely unless you're looking to get into management (Most positions of which are filled by basics in my experience) that they will care what it's in. I can't say for sure, as my friends have referred me most of my jobs, but I'm pretty sure that my degree had no part in it. Good on you man, I hope that you'll stay around. I truly look forward to your thoughts.

A true American Hero... Why aren't the feminist waving the Sally Ride flag?

PM my ass! You two are the perfect ones to have this conversation! C'mon...I want to see!

If you have been working full time in EMS for 7 years then there is no question that you are cut out for it, but that certainly doesn't imply that you wouldn't prefer to do something else. Choose a different path if you want. It's something that we all consider and many of us do, but don't allow yourself to believe that you've done so because you don't have the stones for EMS, ok?

(Hey Az! Welcome back! I've missed you here!) (Carry on...)

Annie! You're back! We've been missing you! Awesome, and heartbreaking post....

Sorry all, I should have been much more clear. Those are all really, really good ideas, but this has to be something that can be written, that a local national can understand (Think of s/s that you would give to a younger child as a guide. Not because they're stupid, as they're certainly not, but thinking about medicine in any none gross context isn't something that they have experience with.), but also, to a lesser degree hold them accountable for the decisions that they make. I'm out of this location in two weeks. They've replaced our positions with Aussie medics, so even the limited ability for training that I might have had is undoable now. It's just something I want to try and leave in place before I go. I was thinking along the lines of... Are they awake? Can they speak clearly? Can they walk unaided? Something like that, which seems very simple until I try and turn it into a decision tree, and then it can get complicated quickly, so I need to find a solution that allows a very clear distinction between "This person has a cold, it's ok to take them or allow them to walk to the clinic." "I don't know what's going on so I should have a medical person evaluate before making a decision." "Holy shit, I need an ambulance now! (on the more none obvious examples) Their fear is that, and it's valid as the Papuans fake severe illness commonly, is that they will activate an emergency only to find that there was nothing significantly wrong with the person, therefor getting in trouble for an unnecessary activation. They have dragged fully unresponsive patients into the clinic to avoid this. I know it's not an easy problem...I'm grateful for your help!!

Unpretentious? Now that she has her fancy new job to you see her hanging out here with the great unwashed? Nope...to good for us now....breaks my heart....