DwayneEMTP

Heh...yeah. Thus the nickname 'Yeti.' Thanks all. I wasn't worried really, but I do feel better knowing that it's not an uncommon condition. Dwayne

Oh Kaisu...I'm so sorry. Though we're far apart in body, I'll be with you in my thoughts. How a life of such pain could build a person of such amazing kindness and spirit...well, I just don't get that. But I'm grateful to be your friend. I've got nothing but respect for your brother's battle, and sadness that he couldn't find in the peace he deserved in this life. Perhaps he's found it now. Thoughts for peace and healing for you and your mom and all that loved your brother. Don't ever be afraid to use my number...I'd consider it a favor if you'd let me help if I can, otherwise I'll give you your space for now. Though I will track your little ass down sooner or later... Love you Kaisu, Dwayne

So, Dylan has hit puberty, 15 yrs old, and (Oh, dear God!) all that that entails. My question is, though he began developing normal body hair at puberty, pubic hair, leg hair and all, he seems extremely hairy from the waist down, with almost no hair, other than on his head, from the waist up. This includes armpit hair, of which he has almost none. This got me to wondering, as his autism causes me me to question many things, whether or not this is normal for teen boys? If I didn't know him, and were to expose him from the feet up, by the time I got to his head I would expect to have found a really hairy chest and full beard, yet, to date, he is nearly smooth on his upper body. What made me think of this as unusual actually is watching him get out of the shower and being reminded of one of those half man, half horse mythical creatures... As autism is sometimes believed to be 'extreme maleness' I was curious if this could be a symptom of that that I've not been exposed to yet, but having only one child, have no idea if perhaps this is the way boys develop? Any advice? I've tried Googling,(tons of hits for razors, waxes, creams and hypertrichosis) and searching the medical forums, (hypertrichosis) but what to use for a search term? I know this is personal, and perhaps weird, but thought that it might also make for an interesting discussion. Thanks all... Dwayne

I had this conversation recently with another member here, and I'll tell you what I told them, right, wrong or indifferent. You are not part of the team. You are the leader of the team. You are not another cog in the wheel, you are the main gear. You can laugh and joke and have fun with the team, but in the end, this is YOUR call. You have chosen to step up to the plate and become a medic, you no longer have the right to share responsibility for your patients care. Your call, your patient, your team to use, including their knowledge when necessary, to solve problems, but not yours to shirk your responsibility off onto. I sucked at this when I first started. I often thought, "Bob has been doing this forever, this patient is in the toilet, I should ask him what's wrong, treat accordingly, and spend the time to learn on another patient that isn't so sick." Stupid, right? But that was my limp dick idea of patient advocacy. To let whoever seemed smartest of most experienced make decision while I was learning. How convenient that I was always the least smart and least experienced so I didn't ever really have to take responsibility. Also, it turned out that my logic was pretty friggin' good most times. There have been many threads here about the patients that we regret, the ones that haunt us. You know what? I don't have any dead patients that haunt me, but there are several from early on when I chose to take the advice of someone else when I was confident that I knew what was going on, and turned out retarding the patients condition instead of improving it..just like I believed that it would. I cringe when I think of walking into the hospital with my patient in much worse condition than necessary and having the nurses/doc ask..."Why did you do X instead of Y??" And the only honest answer I could have given, had I chose to be honest, was, "Because I'm a pussy and I didn't want to be responsible for making my own decisions." I used to try and figure out what I thought was wrong, decide what I thought I should do, compare that to what I believed that smart people around me would do, what the protocols said, what the doc was going to say when I got to the ER, what the jury might say should I be wrong...and finally thought, "Fuck this....I'm not smart enough to run all of those angles. I can only do my best if I commit both brain cells to a working diagnosis and logical treatment plan according to ME." And you know what man? People WILL speak up if they think that you're making a mistake. They really will. Often you will have to choose to continue on your path instead of take their advice, but they can respect that too. And they will keep quiet and jump right up on your band wagon to help the instant that they see that you are confident enough to follow. And you know what else? When you show the backbone to lead, people will actually be supportive, even when you're wrong. Because only a coward that does/tries nothing is going to succeed all the time. You can't have confidence in your decisions until you actually begin to make your own decisions. Until then you will continue to just make yourself scared. Leading seems scary from the outside looking in, but it's really just a paper dragon. Next call, fuck all what anyone thinks and lead. Use those Jr to you and Sr to you in any way that makes sense to you and, judging from your posts, I'm CERTAIN that you will find that you've been running from shadows. I guarantee you, and I rarely feel confident speaking for this amazing group of people, that one thing everyone here is certain of, is that you WILL choose to lead. You can do it today, or you can live through weeks of humiliation first, but it's going to happen. What are you waiting for? Dwayne

A2L, man, it's good to see you! I've missed you here Brother, as I'm sure many others have as well. I think that the replies give you a good idea of both sides of the argument. As you can see, the major reason for not giving it in the USA if you're confident that the patient has a prescription for it is legal, not medical. Also, as pointed out, the question is good, but the one place that you went off into the ditch is asking if you should call an ambulance should things not improve. The ambulance should have been on the way the moment you wondered if O2 was necessary or not. If they called an ambulance the chances of them improving are small, and retarding great. Play the odds and get ALS enroute if possible. And if this is an teen/adult patient the odds are excellent that they will know exactly if it's acute, how severe it is, what the cause and rapidity of onset means for their immediate future, etc. Ask them. And if they are having too much trouble breathing to answer, know that you/they are already in big trouble and get people moving... Good question man... Dwayne

Yeah Mike, that was my niece, thanks for asking after her! She died about 7-8 months after those posts, but she certainly enjoyed visiting and hearing from those here at the City...some that she became friends with until she was gone... Pretty damn cool... Dwayne

Heh Ruffster, I was laughing with Babs about that. As I'm white I don't really get an opinion at all. How is it that whites know nothing about the black experience, but blacks know exactly what it is to be white? (Again, generalizing from the small/vocal subset of radicals) Crotchity, the 20% of the fire dept that is black...who's dick did they have to suck, who's lawn did they mow, who's car did they wax to get those positions? As you claim that it is impossible for them to have done so with talent and hard work, how did they get there? It just occurs to me that you likely see them as traitors, don't you? Serious question. I'd be willing to bet that you are angry at them for their success as it further weakens your argument. Though of course, I'm thinking out loud as I know there is no chance that you, for all of your self righteousness bluster would ever answer such a question honestly. I believe the reason you get the responses that you get here, the lack of meaningful dialog, (with you, as I believe that there is much around you) is that you are so racially biased as to be unable to EVER see an option for a black man's failure other than the white mans repression. I just came off of working the BP oil spill in LA. I'm willing to bet that more than 80% of the supervisors I worked for, or near, were black. Many of them BP representatives. Try addressing some of the hard questions man, and addressing them like an intelligent adult instead of a petulant child and I'm willing to bet you will see a completely different opportunity to make your points. I'm also willing to bet that you will find that many here come closer to sharing many of your opinions than you think. I mean, come on, one of your arguments is that I'm racist because Chris Rock says so? A fabulously successful black man with the opinion that a black man can't succeed? The hypocrisy is stunning. When you live in a world of absolutes you actually live in a world of lies. There are very few absolutes. Have blacks been repressed by whites? Sure, but so have the Irish, Chinese, Japanese, French Canadians, women, the poor, yadda, yadda, yadda....but many, if not most, of their grandest strides have been made with their white brothers and sisters at their side. Suck it up princess and get real...then maybe you can do some good instead of just spewing tired, ignorant, 60 year old sewage over those that used to value your opinion. Dwayne Dwayne

You know, I had a conversation very much like this online with a feminist a few months ago. She was up in arms because she knew of a girl that got drunk at a party, ended up having sex with some drunk kid, and the next day called it rape. I asked her if this girl had been physically damaged in some way, and she said that she had not, but because of her level of intoxication she was defenseless and that made it rape. I asked her if the boy was also intoxicated, to which she said that it didn't matter, he should have known better. She was enraged when this kid wasn't arrested for this heinous crime. Not every act, nor personal failure needs a law created to allow you to escape responsibility. Some things suck. That is how we learn to prepare to avoid them in the future. These attitudes towards women hurt my heart in the same way that Crotchity's concerning blacks do. They scream that they are equal in every way yet tiny but very vocal sub groups constantly fight for the special considerations that we normally reserve for children, animals and the mentally infirm. I believe that both groups are insulted and defined by these exaggerated special protections and their ability to fully participate retarded. Not by the rules that exist, though I certainly do believe that racism is alive and well, (as is agism, sexism, weightism, etc) but by the constant reminder that these groups must be treated like mentally damaged children or those that have succeeded through hard work and commitment will face the wrath of the politically correct. Crotchity's claims that the system was so biased that a black man can't compete spits in the face of the 20% of the fire dept that have chosen to do just that. Anyone remember that movie, some horror flick where a white supremest and a black gang member are caged next to each other? At one point the black man mentions something about the white wanting to kill him. The white man says something like, "Kill you? I love you man! You've killed more n*ggers than I ever could!" That is where I see the Crotchity's of the world. A toxin to their race. Weakening them from the inside and causing them to be ostracized in general. Unfortunately though I see white attitudes changing, I see no sign that Crotchity will ever choose to stop repressing the race that he hollowly claims to have so much love for. Dwayne Edited to ad text in italics. Second edit. "The Equal Employment Opportunity Commission (EEOC) ruled that Chicago was “twice as likely to hire white applicants than black applicants.” Ironically, blacks are overrepresented in the EEOC by 625 percent, but I don’t think the bloated agency has to worry about being sued." http://lashawnbarber.com/archives/2005/03/26/racist/ Surely then you are outraged by this? Dwayne

Hey Mobes...sorry to hear about that brother..I truly am. How does this effect you in your work, short term and long? What kind of presurgical interventions will be available now that you finally have a diagnosis and will you finally see some relief perhaps with them in place? Keep your chin up man....And no need to apologize for not being here...just knock it off and all will be forgiven. We need you here... Dwayne

Is there a specific definition of 'massive' in the medical community Doc? Or is it an 'Oh shit...he's gonna need a ton of blood' call? Not criticizing as I can't see a down side to this either. Or, is there a down side to using it on patients that won't require massive transfusions? Say, the medic that freaks out of a distal, isolated amputation. Pretty cool find... Dwayne

During the hearings they had pretty sophisticated overhead camera coverage, infrared and such, I'm not sure what was creating the images but they were clear as a bell. It showed a tank push in on one end of the building, an explosion, and then the fire begin to burn. The guys in the tank swear that there was no explosion, that they didn't start the fire, but the film is pretty clear. I don't remember for sure but it seems to me the same scenario was played out on the other end of the building. They'd had an FBI agent living there for some time, undercover, and during the Congressional hearings testified that not only did he now see the weapons that were alleged, but also that David Koresh drank in the same bar 5 nights per week...that there was never any reason to try and take him by force on the compound. And this from an Febee... I don't know what the motivation for the attack was but it was obviously not guns, as, as Mr. Bono noted, you don't charge a well armed enemy in a livestock trailer covered with a plastic tarp. All those people murdered and not a single official held accountable. I'm not a radical, but I can certainly see why the radicals would consider that an act of war committed by our government against our own people and our constitution. Dwayne Dwayne

I would challenge any of those claiming that the fires were started in many areas to provide proof of that. I was unemployed during the congressional hearing when this was reviewed...I watched very minute...A few things I remember clearly... The video of the fire starting from the tank...Once source The video of the earth movers turning the cars so that the bullet holes facing the FBI would appear to be facing the BDs. You MUST explain the missing front door. The testimony of the FBI snipers refusing to participate in the project with the rules of engagement hand written on a piece of paper. The video of the FBI claiming that they were there to confiscate weapons, up to and including .50 caliber weapons and Sonny Bono asking "Is approaching an enemy that has access to .50 caliber weapons normally done with a livestock trailer covered by a plastic tarp?" What a bunch of nonsense to say that the mosque should just move to another place. Have you been to New York? Is it your belief that you can just pick and choose apiece of property to build on? It's clear that the property for the mosque was purchased long before 911. Do you really want to compare the crimes committed by the Taliban to those committed Christians? Yeah, I didn't think so. The crimes committed by Christians are far and away the most heinous. There's no question there.... The vast majority of Taliban are being tracked down and killed by Muslims. Up to the time of Jesus the King James Bible and the Koran are the same document. There are no serious questions there in my opinion... For me..our Muslim brothers and sisters are no different than our Christian, Buddhist, Atheist brothers and sisters. Until they, as individuals or groups, choose to do evil against my family or country, they have the same rights and privileges as everyone else. Dwayne

This is the one that makes me batshit crazy! "Why didn't you manage their pain?" "Well, they were old/young/fat/skinny/drunk (take your pick) and I was afraid they'd stop breathing." "Stop breathing? Wasn't the use of a BVM in, say, the first week of EMTB class?" And I get even crazier when they try and turn their fear into a virtue. "I guess if you want to take a chance on killing your patients, then you go ahead! I'm hear to make mine better, not worse!" Wankers...... +5 Man..this is another one. Nice. Dwayne

The ER doc let me reduce a patellar dislocation once. It was really simple, and went it just exactly as he said it would. And the instant relief from "Oh My God" to, "Hell, I can go play ball!" was shocking. This may be a case where manipulation over medication would be a superior treatment. I do tend to agree with you in theory about creating bigger problems by just running drugs and letting the edema develop, but again, I'm not sure if that is a true issue or just one I've come to believe. In my last service, as with this one, we use narcs and benzos together on dislocations. That seems to bring a lot of relief, and in theory will help with the spasm from the dislocated joint, but I have no evidence to support this either. Great question. But as the doc said, unless we can be sure that a dislocation is not also, or instead, a fracture, then it seems a ton of damage can be done in the field. Though I've had one on myself, and transported several patellar dislocations and it's tough to imagine confusing it for anything else. Dwayne

Yeah, not a fan. I once got into a pissing match with Fire for wanting to start an EJ on a diabetic that had no thermal regulation. She was unable to speak and spent here entire day buried under several quilts. Her providers were drunks and drug addicts. My argument was that I didn't want to create that wound where it would always be hidden as well as obvious visual evidence of compromised circulation. I thought it better to place it where it would constantly be seen and so given a better chance to be monitored and cared for. Fire, this was in the Springs where the non transporting fire dept had control of scene and pt until released, disagreed and made 4-5 IV attempts in her legs before finally getting a 20g or some such. I like the foot and leg veins, but not for diabetics if I can help it. Restricted circulation plus often restricted visibility seems like it would be a bad match. I'm not sure if it actually is, but intuitively it seems so... Good to have you back USA! I'm excited to see a bunch of our heavy hitters crawling up out of their holes! Dwayne

I don't think it's really fecal matter if they can vomit it. I can't remember what's it's called before though. And I wonder that it did smell like? Not feces I'm thinking as it's not been exposed to the lower gut yet...interesting... Dwayne

Yeah, the most times that I've seen that is with people that are insecure. Plus, they don't tend to like hot chicks much, but in my experience, most women don't... :-) But certainly busy nurses have no time for you being coy, or timid. You need to ask them to sign it when you're near enough for them to do so, pen in hand, with a certainty that they are going to do just that. Show respect for their hectic schedule, and in my experience, most often, they will do the same for you. Be confident and remember that as it's your job to give a short, clear, thorough report, it's theirs to sign the friggin' paperwork. Don't stand aside and wait. Step up, hold out your report and ask them to sign it. Of course that assumes she's not doing compressions or some such. Should s/he refuse find a charge nurse and explain that you understand that they're busy, but that you need to get back in service. My experience has been that the bitchy "I'll do that on my time" nurses are rare. And then, simply blocking their path to make it clear that I'm not going to suck anyone's weenie for the privileged of having them do their job usually gets it done. Just make sure that you're not going in with the attitude that many are going to try and force feed you. First, that all nurses are bitches. Stay out of the maternity ward and that most often isn't true. And that they are on a power trip because they can't do anything but wipe asses without a doctors consent. It's untrue. And remember, for every professional medic that wants to do good work and get back out on the street, that has respect for the nurses as a committed, intelligent continuing part of our team, they've had to deal with a gazillion 300# shitheads that thought they were Gods gift to medicine and the most important person in the building. Keep your chin up girl... Dwayne

Tcripp, why would you use O2 on this patient at this point in the scenario? Also, something that I've been curious about for ages. After intubation, in this patient, why a BVM. I think we had this debate once that, as no collar without a longboard, no tube without a BVM. How come? Overseas it wasn't common, but not uncommon to be delivered patients that had been intubated for a while without ever coming into contact with a BVM. When they were quiet and breathing quietly/sufficiently I simply left them as they were. I don't see the need to assist vents in a patient that is doing perfectly well on their own. (Making the assumption that his respiration, though rapid, are also exhibiting adequate tidal volume, and pt appears physically capable of maintaining this state.) Now, having said that, I've never intubated a patient that I didn't bag, but sometimes only because I had no idea how I would explain not doing so to the hospital when I rolled in. Yeah, I know, probably an idiotic question...Just add it to my already long list of idiotic questions.. But with an inline ETCO2, though I may want to protect his airway, I can't see why I would want/need to assist vents at this point. Again, assuming that we're not dealing with other pulmonary pathologies not mentioned up to this point. Dwayne Edited for spelling...

I've missed you here Brother.. Sorry to hear that things have been rough... Chip up... Dwayne

Awesome answers PCP... I'm sorry I don't have time to get back to it right now, but it looks like you're being well cared for here.. I'll jump back when I have a few minutes in a row to concentrate. Thanks for taking it seriously, and in the spirit intended. Dwayne

Hey Daniel, welcome to the City man. When are you starting? What are you EMS goals, if you have them? Good to have you here. Jump in. Participation is paramount to getting the full benefit of the site. I look forward to your thoughts.. Dwayne

+1 Man, that is the statement of the month right there. Though I believe that some of that will depend on coping mechanisms as well. If you cope poorly more than likely you're unable to care deeply without creating issues for yourself. It's good to have you here, and to get to hear your thoughts. When are you going to do the right thing and turn that EMT into an EMTP? :-) We've got some basic providers here that are crazy smart..it would be nice to see them as leaders on the street as well.. Dwayne

You've been here longer than that Babe. You mean does the fact that he made the comments that science based...anything, is a hoax, that it's obvious that the autism/vacc issues that have been disproved and re disproved for a generation is obviously a govt coverup, that every disease to come down the pipe in the last 50 years is the white mans terrorist weapon to kill the 'coloreds' is a given fact, gives us trouble? New folks always love Crotchity. He plays the martyr, the victim, the lone voice just trying to bring a new perspective, but if you'll look back at the people in this thread you'll find the majority to be the most open minded, fair, kind people on the City. And you will have no trouble if you look back through his posts seeing that he is a bigot and a troll. Like his mysterious 'family member' from the doctor's office in this thread he most often has a 'friend' or 'family member' with inside information that no one else has, he just never has any evidence to back it up. There is never anything we like better than a fresh, contrary opinion. But if it can't be backed up with science then we ask that you at least be able to back it up with logic, and he can rarely, if ever, do either. But, I won't convince you I'm guess. I just ask that you mark my words, as after giving him the benefit of the doubt, as we've all done a million times, you too will be disappointed to find that he's taken you for a ride. How do I know? Cause I spent a few years trumpeting his cause while folks told me the same thing. What a complete waste of valuable time. Dwayne

Yeah man, we have folks that promote their stuff in here without buying ads sometimes, but they at least try and participate so that they contribute to the site. So far your posts are just spam...

I'm not sure if you're responding to my post or not, but if not, you probably should be. And if so, I'm afraid that I've not made myself very clear. When I talk about dehumanizing (I don't remember if I used that term or not, but it's not inaccurate.) I think that I'm talking more about necessary focus. In fact it has a nearly perfect inverse relationship to the severity of the pts pathology. As the patient gets better, their humanness comes more into focus. For example I once has a young boy that had been ejected from a vehicle and skidded down the asphalt. He had multiple fractures to both arms, and one leg, lots of skin missing, his nose nearly gone. In my mind I don't see a wounded child for more than just a second or two. I see a set of pathologies that is trying to kill a kid, and trying to defeat me. And that really pisses me off. I was told later, when everyone was worried for my metal health, about his horrible screaming, but to tell the truth, though I remember being supremely confident that his airway was not my immediate priority, I don't really remember the screaming. I remember trying to figure out what I was going to do about all of the fluid loss. Start plugging holes, or focus on an IV and get fluids running first? I was running L/S with only unskilled volunteers in back so I didn't really have an option to hand off responsibilities. My little pea brain was cataloging leaks as I finished cutting off his clothes, lining up in my head decent IV sites, had someone crank up the heat in the back, all because I saw this child being attacked from all of these areas, and was attacking back.The pathology was trying to drain him dry, so I stopped it with bandages and fluids, it was trying to cheat him out of his arms and legs, so I made sure I kept them straight-ish and had distal pulses, and stopped it, the pathology was trying to make him hypothermic, so I shut it's ass down with heat.. Man, it occurs to me that I must sound like a complete moron...But, there you have it...It truly is the way that I see forggy calls..like a mini war. As I started to gain on the situation the child just sort of started coming into focus and I went immediately to pain management (Approx.40 min transport with no helicopter avail.) Up to that point you could have asked me his race, age, hair color, and I would have had no idea. But as I got some good vitals, and got the bleeding slowed, and had my fluids running, that changed. I had time now to be emotionally kind. But I don't believe that being emotionally attached at any level, in any way would have been productive to my care prior to that time. Anyway. I think that it's because I love my patients that I become so focused, not the opposite. Of course, like all of us, I could just be bullshitting myself. Do I believe that it's impossible to do all of those things in a reasonable amount of time and still be emotionally attached? Sure, I believe better medics/nurses/doctors than myself do it every day. But that is the way my mind works...good, bad or indifferent. And if it sounds as if I was offended by your statement, man, that's just the weakness of my communication here. I liked it a lot, but wanted to try and make sure that I left no one with the impression that I believe being an ice cube is a good way to do medicine. I think love is awesome medicine for every patient, if you have time. Dwayne