DwayneEMTP

Did you copy/retype that from the scenario gave you, or did you retype it from memory? If from memory...good on you man. There is a lot of information there.. Good calls, though I'm going to disagree with my peers regarding giving the Nitro. This pt is obviously in trouble, she's already got a self administered nitro script which will allow her to take several doses without starting an IV on herself, so I think that Nitro was a good call. She's got every hallmark symptom for a significant MI, and she's missing those significant for IWMI, bradycardia/hypotension* and at least not reported, likely not checked at this level, JVD (jugular vein distention) though as a hallmark isn't always noticeable in all patients. Depending on what was reported to the doc I'm surprised that he withheld a little baby aspirin, but I'm sure he had good reasons for that... So anyway. Would I prefer an IV before giving Nitro? Of course...but it sounds as if we'd rather watch this chick die than take a chance on killing her...May be the better option of course, though in my limited experience I've rarely, very rarely, seen an exciting drop in B/P secondary to nitro when the patient wasn't already borderline hypotensive. This heart is hungry, and getting tired, and there's a chance that the Nitro can help at least a little bit with both issues. Risk benefit based on original vitals is one sided in my opinion. (Yeah, I know the science says that it works for shit, but it's great in theory, and it's really the only tool that I have that may help this rapidly declining patient) Bottom line is that if I run on this patient and say...the Terminator blew up my ambulance and jump bag, but somehow my bottle of nitro was spared, I'm going to try and improve her condition with Nitro instead of sit on my hands waiting to do CPR. (Of course I know no one would be sitting on their hands..but you know what I mean) Cool thread... Dwayne Edited to add citation. *http://www.cepcp.ca/main/paramedic/cme/Section%202.pdf (pg 5) Also, Scrat, it's good to see you back man! I miss having you here... Dwayne

Again I'm afraid I don't have a hard number. In one patient I might feel that the pulse goes from full at 72 to slightly thready at 90 and take that as a positive sign. Another might be full at 72 yet bounding at 82 and I consider that significant. Actually, I wanted to lie really bad on this because I'm kind of embarrassed to admit that I've never really taken orthos very seriously. It's like the GCS, it seems everyone does it but me, and has really good reasons for it, but I just fail to see them. I too am excited to see where this thread is going. Dwayne

I've not used this much, and to be honest, when I do I don't do a thorough job of it. If I sit them up and they are dizzy and/or their pulse increases significantly I've used this as a positive sign, though don't report it as positive orthos. But I believe that the time from position change to time of reassessment of vitals should be two minutes or more? Dwayne

No cost benefit to consider if that was the promise that they made when selling their product. If the swap is part of the promotion then swap they should. Didn't ignore your post Island, it's just that though I've used them I've never been involved in their replacement, so have no information or offer.. Dwayne

Alright man...I'm calling bullshit now. Trolling is trolling... Dwayne

Were you able to text your friends from your hospital bed while you had that migraine? Just curious... :-) Dwayne Edited for spelling only.

See, that's one of the reasons I'm glad that you're here..You being the only one to notice that there was a $64,000 dollar learning question hidden in that post... Would you Yeti? Do it differently? How come? Dwayne

Ahh..got it. I couldn't remember what you did for a living or your cert level...I was assuming that they would be looking for EMS all over the place as normally happens with the floods... Wasn't trying to bust your ovaries girl.. Dwayne

Yeah man, welcome to EMS in general. A couple of things...you may not have taken Cspine as soon as you should have, but what I see much more often than that is people taking Cspine before they bother to assess their patients. Also, having someone mention something that you forgot is not a failure necessarily on your part but is certainly a success on theirs. The firemen that were talking but didn't have the sacks to step up and do the right thing...they're the pussies in this scenario, not you. I once had my basic partner during a code yell, "Could everyone shut up for a second! Womack! Do you want me to push bicarb on this patient! I need an answer please!" Did I fail? Sort of, but we were running the code with all volunteers out in the middle of nowhere and I was trying to keep them off of each other and allow them to rotate in for compressions and bagging and such...but it wasn't about my failure in this instance, in my opinion, nearly so much about his success. He covered my ass when I mistakenly got distracted for a minute...Good on him. If you spend even one second worrying about what people are saying about you on scene then you are wasting valuable mental resources. If you spend one second listening to others talk about what someone may have said about you on scene, you're even a bigger dork. Those people that have something to criticize after the call, face to face? I'd listen to them..at least they've got the balls to try and help you to improve. New places are always hard man...and it sounds like this one may be worse than some. But you can do this..stay away from the negative energy, spread good energy when you can and let the rest work it'self out... Dwayne

Yeah, and good on you for looking that up. It also says in there somewhere, another ol' saw, that discoloration from the nipple line up is a hallmark of a Pulmonary embolus. I'd swear that I've see it, though as I've always know that that is what it was, and knew when I saw it the pathology that the pt had died from, perhaps I was seeing what I expected to see. Anyway, one of the docs called bullshit on it one day and many of us where agast! I mean..."Everybody!" knows that this is a fact... So he asked us to explain it anatomically/physiologically...a bunch of us tried for months, just for bragging rights, yet none of us could get it done... So, all things in our books, as accurate as one would expect them to be, at least I would, are not true. But, though I'm not able to debunk the double blood pressures, I've never heard anyone defend it either. Dwayne

No disrespect meant to you brother. I love to see you participating! Not many do... My comment was in reference to those that repost the 'fireman's prayer' and such shit. You know, the one that ends with, "You've done your time in hell.." What a bunch of crap. They see that fire and EMS are in the 'hero' business, get a basic cert and then suddenly every bullshit cliche' in the book applies to them. They are over worked, over tired, covered in blood, yadda yadda, or at least will be if they ever get off of the couch and actually go and get an EMS job some day. Your post certainly didn't fit this criteria, I only made the comment because I've made it before and didn't want to look like a hypocrite by turning around and doing it myself. Yours were appropriated, and even if, in my opinion, they weren't? Screw it...mine is just one opinion. Thanks for participating man...it's cool to have you here. Dwayne

Yeah, that's what I've been told to...but I've never heard anyone justify this as a physio marker for AAA... I'm not saying that it's not good for anything, I just have no idea what in fact it might be for...people love to say, (Not meaning you Happiness) "Be sure to get a b/p on both arms!" I wanna say that! I just have no idea when to do it! Dwayne

"In any accident, the degree of injury suffered by a patient is inversely proportional to the amount and volume of agonized screaming produced by that patient." Truly, though I hate the passed around sayings, that may be the most important one of all regarding patient care...The more screaming and thrashing there is, thus masking any active/accurate patient participation in care, the more you have to tune it out and get busy getting your own information. Silly quote with a really valid point I think... Dwayne

LOL...yeah, there's more than a few rednecks in Colorado, but I actually spent the majority of my life in Central Arizona...so I hear you girl! I may be doing crew change out of Houston? maybe in 12 days (But who's counting). I'm not sure if that very near you or not? But either way, Texas might not be too bad for a get together assuming you all stop with the friggin' heat and get a little rain.. Anybody up for a get together? Where's cute little Wendy, Matty, Yeti? Dwayne

Why is that? I've heard this a lot, but it's never made much sense to me and I can't find any data to suggest that there should be anything more than the normal/expected few points difference between the two. What is it that you catch with this, and what makes you believe that you've caught it? Not punting your ovaries Babe...truly curious. Dwayne

I'm with the others. I like the forearm for two reasons. It doesn't occlude when they bend their arms plus it's way easier to secure than the ACs in my opinion. Particularly on elderly/allergic patients where you may not want to use tape. Also, on traumas, or any patient really that I need two IVs or that I think that I'm going to be busy on, I try and put them both in the right forearm/AC. This is maybe not a good practice for some reason that I can't see..but it keeps the lines opposite the bench seat where I can see them but don't have to manage them while I'm doing other things. I'm also with Island in using the feet. I'm not sure why people seem to avoid them, I go to them pretty quick on patients with poor availability of access. They're normally easy to secure, don't easily occlude with movement, and as above, keep the lines out of the way if I'm busy. They're a good option I think with the exception of diabetics, where the resulting wound will not be easily monitored by care providers. Dwayne

Cookie, why aren't you working? Aren't you a medic? If even a basic, I know that they are looking for EMS all over up there... Dwayne

Did you verify that B/P yourself, and did you trend it during transport? Any change? I'm with Ruff, within the parameters that you've allowed for this question, there is nothing else significant that you could have done. A 'just in case' IV wouldn't have been out of the question in my opinion, but I doubt I would have done so on this patient. I'm guessing that this time things are more or less what they appear to be, some minor gastric distress. Of course that ASA/transport was spot on. Good job, though I'm curious why you've chosen to keep this within the Basic SOP? Ahhh...wait, you downgraded this call and let your basic partner attend, didn't you? And now someone is trying to jam you up for allowing a BLS provider to attend to an 'ALS' patient? . If so...I'm not opposed to that decision, depending on the partner. Dwayne

Yeah man, that trip was a lot of fun. And my wanderin' eyes aren't completely my fault..she wore that adorable little skirt...Plus she's cute as a button and more than capable of handling her own.. We really need to try and plan another get together. That was fun as hell... Dwayne

Hell, I can't think of a single time that your language has needed correcting. Your grasp of multiple languages is inspiring to me... Unfortunately there is a belief in much of US EMS that if you can pass a test then you are a 'professional provider.' It's often difficult to convince some that you can be a douche on an ambulance simply by passing a test, but if you want to be a professional then spelling, punctuation and grammar are really important. Your one of the posters that I really look forward to reading. Your posts are always kind, open minded, intelligent and curious...I'm grateful that you're here brother. Dwayne

Man...tough go Babe... I wish I had encouraging things to say, but we both know the, "it will be fine" and "time heals all" schtick in these situations are bullshit. Keep your chin up. Try and put this time to some use...Scotch is ok, but try and chase it with a liberal dose of exercise. As tough as it must be, try and find some way to move your family forward, if only in something really small, every day. Nothing else should be considered acceptable. Stay healthy, get physically stronger, move your family forward, otherwise your mind can go into some really ugly places...And you know damn well that you and I both are REALLY to old to play that destructive game, right? Some really excellent advice I received once that will be familiar to many..."When you don't know what to do...breath in, breath out, put one foot in front of the other, and clean your house." Sending thoughts for strength to you from the Womacks in Colorado... Dwayne

Wow, awesome holier than thou rant hotshot. Actually it was a sincere question. We get people from all over the world to this site. Often they are criticized for their spelling and grammar before anyone discovers that English is not their first language. It was an honest, and prudent question. Should you choose to give such a poster 'advice' without also explaining that being able to spell, punctuate, and capitalize is vitally important to being able to succeed in this business, then you are just talking out of your ass. I notice that you passed the NREMT on your first attempt and now feel qualified to explain to everyone 'The' way to pass it. You're arrogance at your level of EMS is astounding. Just because you believe that all you need to do to participate in this business is pass one of the simplest tests ever, doesn't mean that that is the case. Not everyone understands that the career that they chose will allow you to train for it without expecting you to be proficient in the things that you actually need to succeed in it. You're need to kiss the posters ass instead of helping to educate them is cruel, and unfair, and certainly unproductive. And I'm 'pretty sure' that I wrote 'your' and not 'you.' Perhaps your reading comprehension is part of our issue. There was nothing enjoyable about the question, as stated above. And I do have excellent resources for passing the test. It's called EMTBasic training. If this person can't pass the test after passing the class, and seems unable to form coherent sentences then knock yourself out sending them to test prep sites all day long big guy...that's not what they need and it's not going to get it done. Something else is broken and without knowing what that is there is no way to help. Didn't they teach you that in your hotshot Basic class? Assess and then treat? How about if you do something in EMS and/or post something worthwhile on the City before you try and stomp your feet. You'll look less silly. Dwayne Edit. After posting I notice that you are in the Army. If you've been deployed then I thank your for your service and am truly grateful that you've helped to keep the boogyman out of my families back yard. Unfortunately that doesn't change the fact that your post, though perhaps good in spirit, is completely off in the ditch as far as being truly kind as opposed to actually unkind to the person needing assistance.

Holy shit...great point, and good politicians all, in my opinion. I stand corrected. Dwayne

Hell LS, when did you get so temperamental? The debates don't even get interesting until someone tells you why you're off in the ditch. And I'm not sure how I played into that. I addressed your post with sincere questions, non of which you answered. I didn't think that I had to wrap posts to you in velvet...and if I do then we've hit a significant roadblock in our communication. You may not have noticed, but that's not my strong suit. The main question that I had was this, what about his condition would lead you to believe that he shouldn't be allowed to make his own adult decisions? And if you will remove his right to participate in high risk activities, why would you choose not to limit those of non damaged people as well? And if you do believe that he retains the same rights as non injured people, and that decisions on high risk activities should be monitored by 'someone', then aren't we then, logically, required to eliminate rock climbing, motorcycle riding, and anything else with a higher than average likelihood of getting you killed..because obviously anyone participating in those sports is showing themselves to be incapable of making their own rational decisions it seem? For me...I believe that intellectually you are nearly unrecognizable as the person you were a year or two ago..unfortunately you can still be a little thin skinned when your ideas are challenged. Suck it up cupcake and bring it! Dwayne

Say, brother, is English your first language? Not busting your balls, hopefully...just curious.. Dwayne