DwayneEMTP

No need at all for an apology. After I saw what you wrote it made me rethink everything that I had written. I'm grateful that you didn't allow it to stand as it was. And I'm grateful that you had the balls to speak up. I'm practically a mistake factory. And often the things I write with the best intentions end up sounding just the opposite. I took it at face value. Not as a personal attack, but as the challenge you intended. And I'm grateful for it. Given the choice to proceed in error or just keep your mouth shut? Man, we can't learn from anyone if they won't speak. Thanks again Brother. I love your posts, and I'm grateful that you're here. Dwayne

Agreed. But I've never really had to have the, "Everyone is evil because I'm unhappy." conversation with any of them. I used to train Arabian horses in California. If you're not familiar with the field, it is dominated by gay men and women. It was not uncommon to sit around at night and drink with 50 or 60 people with me being the only heterosexual in the crowd. Or at least if there were others they were in the closet and didn't make themselves known. One of my best friends, and a really, really good medic while I was in Afghanistan used to start the morning whenever we got a new batch of medics, by walking his big 350# ass out into the hallway wearing only a thong and nipple rings as thick as my fingers and exclaim, "Ahhhhh...I love the smell of Caucasian cock and ass pussy in the morning!" just to see who would freak out. So I don't know if it was your intention to imply that I've been sheltered, or perhaps my comments come from a poorly hidden homophobia, but neither is true. I didn't mean to imply the gay population in general with my comments, but meant to respond only to those conversations that have taken place here on the City. I've had hundreds, maybe thousands of hours of conversations with those whose color, sexuality and/or lifestyles are different than my own. But I've never met anyone from the militant subgroups that was able to have this sort of conversation with any type of intelligent direction or any ability to admit that they may have misunderstood something that has been said or done to them. If you add 'radical' to the front of any title, my experience with them has proved to be shallow and frustrating. My apologies for not being more clear in that regard. I sometimes get a little bit puffed up on these topics as some of the most amazing people I've had the pleasure to know have come from the 'minorities.' Women had a hard time in Afg, despite many of the strongest medics I know being women because of the radical feminist/unfounded sexual harassment crowds. Everyone was afraid of them. I lost two black friends overseas fighting for their country, and those that I continue to work with are sometimes stunted in their endeavors, not because of their behavior, but because of the behavior of the Crotchity crowd. People are afraid of them. Often people think of gays as flaming, irritating fags, not because most behave that way, (In my experience) but because of those like flaming that represent themselves in a very negative way and then claim to speak for the gay community. Too often these types of people like to crow from the rooftops about the inherint hated that non "whatever" people have for those that are different when in fact many people are simply responding to what those 'different' people have, and are, teaching them. If someone came into this forum with absolutely no opinion of blacks and/or gays, after their interactions with Flaming and Crotch, what do you suppose they would have learned? Love, and acceptance, and brotherhood? Yeah....Not a chance. Dwayne

Man...it would be a battle of inches I think. Experienced intubator or not, I would try really hard to keep from intubating this patient. Though I've not seen this type of patient often, other than the condition I mentioned above I've not seen swelling of the tongue that involved no other part of the upper airway so I'd be really afraid of falling behind the curve on this one. I have no educated opinion on when would be right with this lady. I'm guessing I'd try and avoid intubation until that moment when I though, "Oh shit....I'm losing the airway....I hope I didn't screw around to long..." Dwayne

What I would give to have this conversation with a gay person that could actually fathom the idea that they might possibly be wrong on any given point. The dialog is all constipated because there is so little give and take... Crotchity says, "You've never had sex with a black angus so obviously you're a bigot!" Flaming says, "You've never sucked a dick so obviously you hate fags!" They both say, "I was once looked at sideways at the mall, so I'm repressed! I should be given....something! And it should be free! And......it should come with an apology!" ("From Who?" "From anyone that is not me! Everyone owes me stuff because I've been unhappy!" " " What about other people that have been unhappy too?" "Fuck them! They're repressors! They deserve to suffer! In fact that guy over there? He's suffering because I stomped on his neck! But it's ok....it made me happy...AND HE'S a FUCKING REPRESSOR!" Neither of them is in love with the idea of equality. Neither wants a dialog that will move all people forward. They are both in love with hate. And they are both in love with their victim status. And that, in my opinion is the problem.... I truly wanted to give flaming a chance, but he's not looking for a chance, he's looking to spread his anger, and unhappiness. He's not looking for help to make the world stronger and kinder, he's looking for a crowd to attack, to attempt to maim with passive aggressiveness. Neither are different really than white supremacists, or wild dogs. They're not looking to get better because they've become to much in love with attacking and trying to cause fear. Each is truly the worst enemy to the groups that they claim to represent. And you know what really breaks my heart? They know it. They are both plenty smart enough to know it, but they don't care. And for the record? The word is nigger. It's impossible to have mature, clear, in depth conversations when we use the abbreviations of 4th graders. An no, I didn't learn that word from any of my white friends. Alright then....everyone have a great day! Dwayne

I was listening to Howard Stern, and they had on one of those companies that sends in hot chicks to flirt with husbands to see if they can get them to cheat? And to same tactic used on wives of course.... Anyway, he was asking who the biggest segment of his business was and the guy said that it was husbands wanting to investigate their mistresses, to see if they could trust them to be faithful before they left their wives for them! Man...it's a crazy world.... Dwayne

It's good to see you posting again man.... Staying here, participating, is truly what will separate you from the crowd. It will keep you mentally sharp, and most often, intellectually current.... Have fun! Dwayne

So, do you always use a bougie? I'm not criticizing, but trying to understand. Nealy every patient that I've intubated I've done more or less on my own, calling for cricoid pressure if I thought it would help, but most often it was unnecessary and my partner was busy doing other things. And I've never used a Bougie, though I started carrying one the last few months I worked the street to remind me to try it, but never did. Again, in no way is this meant as an 'I'm better than you', statement. I'm just surprised that the differences in technique haven't come up before now. Dwayne

You lost me here. Are you saying that one person can't intubate a patient without help? Or that one person can't intubate a person without help when a bougie is used? Both I have to disagree with, unless I'm missing something here.... Dwayne

Man..it took it a couple of minutes before I could make sense of it, but when I did it was friggin' awesome!! Way clever.... Dwayne

I'd not thought of the pseudo seizures until Mobey mentioned it. I've treated them, and the first time I medicated, and medicated, and medicated, each time only breaking the seizure for a minute or two...Got into the ER and the Doc yelled, "HEY! STOP THAT NOW!" and they did...grin. I told him, "hell, I'd never thought of trying to shout a seizure away before." He sent me to do some research on pseudo seizures and it was truly amazing to learn about. Benzos aren't breaking the seizure...did you try putting ice in their pants? Time to load and head in. How long is the transport? I can't think of anything else I'd like to ask the mother. But I do want to yell at him to make sure that it's not a pseudo seizure. Any reaction when you placed the IV? Dwayne

Isn't there something else that can cause this condition that's not allergy or ACE inhibitor related? I can't remember...just getting a tickle of something. Thyroid related maybe? Maybe the AIs have nothing to do with this and it's just coincidental. Approximation does not necessarily equal causation. Damn it..saw a patient once when dropping off at the ER. Her tongue was hanging down well below her chin, it was massive! Probably over all about the same size and shape as my open hand...they told me then what it was, and I saw it again after....Hell... Anyway. Does this ring any bells with anyone? Dwayne Edit. Both times I saw it it looked almost exactly like this, though of course I have no idea if this pic is even real...http://img.moonbuggy.org/giant-tongue-woman/

Not blokes, really, as I'm guessing that most like to keep theirs shorter. I just don't see the point really, in being to brief, if I'm not backed up on calls. And I'm not sure how it works there brother, but here, I doubt anyone of note will ever look at my PCR. They'll take my report over the radio, coming in, 15 secs or so, and then my hand off at the hospital, 30 secs at longest most times, but I haven't even written my PCR most times before patient care is well under way. I'll give em a copy, they'll stuff it in a file, unless something goes wrong and they need to review...and that will be that... Dwayne

What Herbie said.... But also, you mentioned that the bezo didn't break the seizure, so I'm guessing that there is more to this story than we've uncovered so far? Dwayne

Holy shit DFIB, I'm going to guess at a philosophy degree? Poking fun, but man, outstanding answer...(Had to minimize the porn in the other window for a sec while I was reading it. Conflicting pleasures you know...) Dwayne

Can you be more specific? I know you can't type it all out, but I would be interested in the broad strokes.... Not busting your balls, just curious what you've found, as your thoughts are always educational. Dwayne

Man...I'm not sure exactly how to describe it exactly, just clear and concise. Though I use very few abbreviations as I don't find that it saves me a lot of time doing computer PCRs. I'm not pretending to be good at PCRs, only to be happy with the information they contain and the order it's contained in, but I'll play and paste one below.. Hell...looking through this I really, really want to change it some, but that seems like a bullshit move for some reason...so here it is, as submitted. Called by neighbor to the the residence of a 46 y/o female. Neighbor states that patient is having difficulty breathing x three days. Neighbor warns that pt is combative and uncooperative. (Note:smell of alcohol and behavior of neighbor causes medic to regard her comments with suspicion) Pt states that she has had a 'little cough' for the past three or four days. Pt denies sob, productive cough, rhinorrhea, tinitus, h/a, throat pain, c/p, dizziness. Pt states to feeling well other than noted cough that she says "probably comes from my smoking." Pt states that she is home bound secondary to "being retarded." Pt denies PPHx other than noted, -Meds. Pt refuses transport to the ER. U/A pt is found to be supine in her bed. Her room is comfortably warm and appears well kept and sanitary, her clothes and person appear recently cleaned. Pt's affect is mild, of good humor, cooperative, but that of a much younger person, perhaps a pre-teen. Pt is AAOx4, appropriately aware of sounds and actions occurring around her, speech is clear/concise/appropriate, PERRL, HEENT unremarkable, neck pliant without pain to palp/ROM, L/S full/equal bilat with very light localized wheezes in R lower lobe, no significant change in sounds with prompted cough, cough unproductive, SPO2 97% r/a, 100% 2L O2, P 84/full/reg, B/P 128/76, skins p/w/d/afebrile to touch, pt appears atraumatic globally to clothed inspection. No s/s of emergent pathology reported or discovered during physical exam. Wheezing without sob, likely chronic. O2 2L n/c placed by Fire prior to medic arrival, vitals, SPO2, historical exam, physical exam. O2 removed, SPO2 falls to 97% and remains there throughout remainder of pt contact. Pt continues to refuse transport. Though pts mentation is well below that expected of a normally developing adult PD states that pt retains her right to refuse, living autonomously with periodic checks from an off site aid. Police report that reporting neighbor has been known to make false EMS activations in the past, stating, "When she gets like this she wants to be a good Samaritan." Based on historical and physical exam medic can find no reason to warrant transport against her will. Medical control contacted and based on medic report agrees. Refusal created, signed by pt, witnessed by PD. Pt reminded to drink plenty of fluids and to reactivate EMS (Call 911) should she feel unwell in any way. No transport. A couple of things about writing PCRs. You may see that there is a lot more to this report than simply medical stuff. The reason being is that when I saw the neighbor, and then after just a few minutes with the patient, I'd decided that I was going to allow her to refuse if she still wanted to after my assessment. I also knew that honoring her wish to stay home, as a patient with special needs, was almost certainly going to get me jammed, and possibly fired when this PCR hit QA/QI. Not because I believed that I was wrong, but because I knew what every other medic at this service would have done. I assumed that they were going to come unwound based on the liability of leaving a special needs patient at home, but was unwilling to, (what I believe would have been violating her rights), brow beat her into my ambulance to cover my ass. which I certainly could have done, as I can do with any child. So you can probably see that my PCR is slanted in that direction. I don't believe that there is anything wrong with that as the decisions being made here were not strictly medical but involved the thought process involved when I made my decisions so I tried to paint the picture that the girl cared for herself all the time, seemed to be doing a fine job of it now, and shouldn't be mugged simply because the drunk neighbor wanted to hang out with the cops and firemen. Not to be confused with Lying on a PCR of course, which I couldn't be more opposed to... Anyway, it's not pretty, and it's far from perfect, and the smart providers here can say more in half the space, but that's the way I do it, give or take a bit... Dwayne

I'm going with coincidental coinciding acid flashback...Where were you exactly during the 60s -80s? Had nothing to do with the beet juice..That's my professional opinion.. I've never heard of that and I'm guessing that you've already googled the hell out of it, so I'm not going to waste my time...but no man...I've got nothing....well, except the more likely explanation above.. Dwayne

Some advice I took from Dustdevil (You don't know him yet) that was golden.. Do you personally know any cops? That is where you should go for report writing skills before you even begin to practice PCRs, if you can. I hired one for a couple of hours as a tutor and man, it changed everything for me about report writing. Not trying to be a smartass.That truly is a great way to go. Dwayne

Hey Nathan, cool to have you! It's always great to get newly certified folks in here to bring the newest information to the old folks...like Herbie... Jump in Brother. I think you'll be surprised at the value that you'll find.. Dwayne

Ok Denny, rule number one. If you say it, unless you state a source of some kind to verify it, we'll assume that it is your opinion. It's ok that you do, but you don't need to state that. We all just have opinions brother, unless we're citing studies.. Second. Good on you...4 years married. Never forget that sex is the key to a long an happy marriage. And, yeah, with each other. Others will give you a bunch of rah rah politically correct bullshit about how it's religion or respect, or commitment, or whatever...but if the sex is good then all of the other parts are running on all cylinders too..... see? Easy... I'll bet that's written on a scroll somewhere but they just haven't found it yet... And that my friend is the one and only visit I'm going to make into your sex life... Why he's still married? Because he's a coward and a pussy. At least that's my take on it... Dwayne

Hey Suze, Welcome back! Damning yourself why? This would seem to be the perfect place to say, "I fucked up, am on the road to recovery, and wouldn't mind reconnecting with some of my old, also fucked up, but more sober friends." Right? I'm glad to see you, and I hope that you'll stay and participate. 'Specially if you're unemployed now...get focused Babe.... Breath in, breath out, put one foot in front of the other and clean your house....plus, keep your brain busy and post on the City...we could use you here. Dwayne

As above, but I'd also like to know if this is a new dilantin script, or did they medicate him because he ran out of his, or forgot to take it, etc. If this is chronic, for how long? Was the condition initiated traumatically? As stated above this is going to boil down to a thorough history. An honest history. This is an excellent example of needing to be confident that your patient will lie to you. Previous/current history, current/recent drug/alcohol use, medication compliance, number/duration of seizure activity should all be regarded with significant suspicion. Good scenario Beib's... Dwayne

Can you say that here? Dwayne

Thanks Ruff, though I not only think that you give my current posts to much credit, but my original posts as well. A few years back I went back through some of my early posts, just to see where I had been, and if I'd made it anywhere...Good God!! Babs had to wrestle the cheese grater from my hands as shredding myself to death seemed the only appropriate punishment for the idiotic shit I subjected you all to. These new posters? Man...after being around here, plus practicing for a few days, they still make me feel like a poser sometimes. They're awesome. Thanks to all for participating. That's cool as hell. And Denny, a last, for now, word of advice? If you follow the path of most energetic new providers that have come before you, we won't see you here any more after a few weeks. The glow wears off. Some folks are going to challenge you to think, and prove that you want to be a good provider, not just a provider, and you may get frustrated and quit. Sometimes this place will piss you off, and other times it may be unfair, but staying here and participating truly will help you to stand out and away from the rest of the EMS sheep. That isn't always the easy way to be, but many of us here believe that it's morally and ethically the best. But staying will take commitment, and a plan. (Speaking of which..it's time to rattle young Mr. Beiber's cage again...) But I have faith in you Brother...You started out different, now lets see if you have the balls to continue the same way. Dwayne

He does sound challenged in some way, but doesn't sound like a savant to me. Did you manage to get him to go with you? In this situation it can be tricky, as, more than likely you're going to discover that mom was the problem. One thing for sure, he has to come with me, or he's going with the police, and that's just not going to happen. Calmness is certainly good, as you know from you Aspie boys, and I'm guessing more than likely you could have just asked him if he wanted to ride in the ambulance and he would have gone. In this case I would have payed close attention to the behaviors between he and his mom and more than likely, if possible, had her ride in the front. If he wouldn't go, then things get hinky. I ran through this with a previous medical director once, about just medicating them early, to save them the emotional and physical trauma of the wrestling match that he would never recover from. He said, 'If you touch him and he resists, well, you have a protocol for medicating combative patients, don't you?" And though I've not run into this situation since that conversation, that is certainly my intention in the future. Medicate early. If you're BLS, at the point that it becomes obvious that he won't come quietly then you need to allow him to retreat to a place where he feels safe and call in ALS. This is not going to go well and the will need to medicate him, if they have the guts to do it. Should you or the cops choose to just tackle him and tie him down you should, from a patient care standpoint, consider this in the same class as violent sexual rape against a child...that is truly the service you are providing at this point...probably worse. No cure all, fix all here girl...but that's the best that I've got. First...do no harm. And if you physically restrain these folks you can certainly never pretend that they weren't harmed. Most likely your biggest job here, if you have the balls/ovaries to truly advocate for your patients, is going to be protecting them from the police who have other things to do and will want him in your truck and gone so that they can get about them. Just don't let it happen... Dwayne