DwayneEMTP

Holy shit Toni, I so get this! Or at least think that I do.... My last basic partner was sharp as a tack, had every intention of furthering his education, and I trusted him...a lot. There were so many times I'd want him to be able to take a call..just to flex his mental muscles/skills but couldn't because the call was outside of his protocols. In Colorado we have quite a bit of leeway for allowing Basics to push drugs in our presence, but not so much leeway to say, "This is almost an ALS call, but not really, and I'm only a few feet away...I want to let him take it.." but couldn't. He was smart enough that pharmacologically he ran all of our codes...but that was about all that I could allow. I don't see any here...have you found anyone else that has such protocols? I'm interested to see if anyone has such a thing... Dwayne

Yeah man, it truly would be awesome to have you back. We've be the worse for you being gone. I hope your new job is giving you the challenges and rewards that you deserve and I hope that your new book is a killer success. (See what a push over I am?) Dwayne

I really like many of your posts Magic, but on this one it appears that you chose a side, became insulting in your defense of it, and despite your own post putting the lie to your logic, are going to simply continue to swear that there is in fact a pink elephant in the room. I've not seen you quite so moody and defensive before. But I'm willing to bet that if you reread the above post that you will see that you have made the exact point that you showed such disdain for me making earlier. Dwayne

Johnboy, your holier than thou argument only works if you, as you continue to do, ignore the time frames. You attempt to present yourself as so far above me that you can't possibly grasp the ignorance of my actions, and yet you are unable to address the simple mathematical problems that a 6 or 7 year old child would solve easily. What's up with that? If it makes you feel really smart to continue to ignore the questions addressed to you, to ignore the most pertinent aspects of the differential and treatment, to continue to regurgitate the simple minded protocol monkey crap that you've given us over and over already...then good for you brother. But fair warning. We aren't the basics that you seem to hang out with that are snowed by your narrow minded cookbook medicine. This is a forum of medical professionals. They, nor I, are fooled by your rah rah bullshit. I would love to debate this with you, and will get right back to doing so just as soon as you address the logical questions that you MUST ignore to continue to make your foolish argument. This patient didn't deserve a trial of Glucagon, this patient deserved to be thoroughly assessed and her current and future possible medical needs addressed most to least critical. You have not even made an EMTB attempt at arguing that so far. You would have fired me? The sad thing, in my opinion, is that in the chickenshit world of cover your ass protocol medicine...there is every chance you will someday rise to a position to be able to do so. Dwayne Edit. For the record, "Continue your research" and "Look it up" is pussy debate tactics. It's not my place to make your argument. If you can't site your sources like an adult then don't use them. It really is that simple. You say that IN Glucagon is the standard of care? I call you a liar. Or perhaps you don't know the definition of "Standard of care." Prove it.

Hey Luke, welcome. Colorado springs here, at least that is my home, but I work in LA right now. Where are you, if you're comfortable saying? Like Herbie said, (Evidently it's 'internet day' at the nursing home), like the streets, the City is a full contact sport. You can sit and read, and maybe get something, or you can participate and I believe that you'll be surprised at the knowledge a good debate can deliver. Good to have you man! Dwayne

Oh please, Kate!! It's impossible to feel sorry for any woman complaining about the lack of male nudity when you can simply walk into any bar and say, "Would someone get naked for me??" And have 50 swinging dicks flopping all over the bar...At least that's what P-Mike tells me.... Besides..I've never gotten the whole naked man thing,,,I think that they should be outlawed in the interest of world beautification. Just sayin'... Dwayne Note to Crotchty. You mentioned making things lighter and my post is in that spirit. If it was in fact your intention to have an honest intellectual discussion on this topic then I truly apologize and will stop trying to be funny...which...as we all know...isn't really one of my strong suits. Just sayin'.

I've got a 2 year medic degree preceded by a year and a half of prerequisites...how long does it take to understand this friggin' thing? Dwayne

So you're saying that to ignore the GCS is to be ignorant of basic pt assessment skills? Not trying to put words in your mouth, but it sounds as if you are one of the few here defending it's value..I'd love to hear your justification. Dwayne

I don't think that there is any type of rule against it, as I've seen it. It just doesn't seem to be done for some reason. Penis envy, maybe? Not sure. I wish we'd get to having full, classy nudity of both sexes on television, on Saturday morning cartoons! Then perhaps we'd stop freaking out over it and we could curb some of the sexual deviancy that the world suffers from.... Cool topic man.. Dwayne

Welcome to the City! I mean that sincerely despite my at least partial, and possibly complete disagreement with your post. I am flattered that it is intelligent, uses whole sentences and supports your points. Again, not at all tongue in cheek... Yeah man, I can see why you don't look for zebras, everyone that needs EMS assistance appears to be a lame horse in your opinion. I wouldn't risk my job over a bunch of losers either. But then again, our practice seems to be different, as mine is full of ill or injured patients. Yours seems to be filled with one type or another of people slowly, purposely, committing suicide. Awesome! Fair enough. What is the mean onset via that delivery? I've not heard of giving it IN, but my guess would be that in this patient, with the presentation as described, her glycogen stores were so minimal that it would have been near useless anyway. What is your optimum window for pharmacological stroke intervention? We have two hours gone now, a min of 60-90 mins to a stroke center, perhaps 50 minutes if I activate Flight for Life now. How long do you want to wait to see if the stroke symptoms resolve with the Glucagon? You are truly going to let this window close so that you can stick to protocol? Also, as you might have seen above, I did not violate protocol to treat this patient. As above. My thought exactly. I thought I did that. You're going to need to back that statement up with current science brother. I've heard that oft repeated, but can't find any current research that supports this except in the near extreme. My mistake. I should have said baseline. Though you already knew that. Yeah man, if I follow your advice then a drunk is a drunk, a warm seizing baby is a febrile seizure, and the window for optimum treatment of a possible stroke closes while I sit on my hands. I'd rather burn my medic ticket and wash cars for a living. Thanks for participating JB...I look forward to your thoughts... Dwayne Not taking it personally at all, in fact, just the opposite. I love that you've jumped right in a decided to debate. There is not one thing so special about me that it should be assumed that I will be right about....well...anything really. I'm grateful to be challenged, though I'm confident that I countered this argument before it was made, in my original post. I'm not sure what is new here? It MIGHT have given me my answers, and it would likely have given them long after I needed/wanted them. Dwayne Edited to correct some clumsier than usual grammar. Not significant changes made.

Interesting question...I'm guessing that you mean without oversight like Albuterol etc, in some places? I'm trying to think of any IV drug that a basic can push on standing orders other than saline...I can't think of any. Why do you ask? Dwayne

You too babe...I thought you'd left us for good!! Great to have you back! Dwayne

No man, not douchy...ok, maybe a little douchy, but I called you out for a couple of reasons. First, to remind folks what we do here and that it's important that we help each other remember the direction we're tying to take. Secondly, because I knew you wouldn't cry about it and I was hoping some of those with a bit thinner skin would see that being criticized truly isn't the end of the world, but sometimes can be the beginning of a conversation. Welcome back brother...we've missed you here! I did get a kick out of your post explaining that sometimes you may be in danger when you should feel the most safe...not sure how many here remember that story... Dwayne

Ok, tell me that I'm not the only one that sees the humor in someone named Crotchity being defended by someone named CrapMagnet? Funny, right? I wish we would ban the use of the term 'ban.' Unless he's following people around being bullyish, then he gets his opinion, in my opinion. At times my opinions have varied a bit...Like that time I got food poisoning on....what's that called? Oh yeah, Tequila, and then spent half the night posting a bunch of shit even I couldn't stand to read the next day. Now, on the other hand. I think that there was two or three other times that I took the opposing stance from Richard, Mike, and Mobey, absolutely confident in my ultimate 'rightness' and ended up being an even bigger dumbass than usual. So in this thread I'm holding out the possibility of other names in the past, or even, based on some of his opinions, that Crotchity may be an alien living amongst us. (Poking fun only) Does he piss me off? Oh yeah, because he most often refuses, where I am concerned, to address the questions that I believe cast doubt upon his theories or opinions. But until he begins to 'flood' the forums, or until he begins to stalk specific users, or until he posts, and no one responds (Yeah, right!) then I welcome his posts the same as any other. Because my liberal heart bleeds for him? Oh no. Because today we ban him for being irritating, tomorrow you ban me for saying fuck, and next week we ban Mobey or Mike for checking folks on their spelling because the City is "jst a plac to hang an chil." No way man...some really good folks have spent a lot of time trying to make this a place where even raunchy ol' broads like CrapMagnet feel welcome...Oh hell...was that slanderous? Yeah, well, fucking ban me. (See, all sorts of badness in that sentence, the worst of which is the word ban, in my opinion.) You know what really pisses me off though? 9115 basically saying, "fuck you all!" in his post and then ending it with 'All the best..." C'mon man...be pissed, don't be pissed, but don't be pissed and then pretend that God can't see you if you make nice in the last sentence. Get in and get dirty brother! No blood no foul... See, this thread isn't a total waste after all! I think that I've show that we can in fact all get along...if everyone will just do what I tell them. Is that so much to ask? Dwayne See! Right there...funny as hell. We'd have missed that.... Just sayin'... Dwayne Edited to fix one of the ever present typos that only appear after hitting the Submit button. No significant changes made.

Sorry brother, but it's pretty obvious that you just come to push your book, not to participate. That makes this spam. A few years ago most of us jumped on board when you used to come to teach and learn, but the, "Hey guys!" is pretty transparent. I wish you luck with your book, but spam is still spam regardless what you may have done several years back. Dwayne

Yeah, Kudos to JTS for not bailing. That was pretty hardcore, as being a Basic doesn't mean that that is all the tools he brings to the task. I happen to know at least a half dozen basics with BS degrees and several with Masters, two at this location with PHDs...so perhaps the criticism was a little premature. Good on you brother. If you choose to continue with your idea, or choose to bail on it, I'd be curious to hear what it was. Perhaps it can be applied to something else EMS or non EMS related? Dwayne

Hey! I just had a great idea! How's about if you all just kiss my rosie red ass!?! :-) Yeah, man. Forgot the date. Chose not to kick ak in the balls for making such a statement without citing it, because he's ak...that won't friggin' happen again! Happy April 1st all!! Dwayne

Yeah, see...that makes sense. But I'm still unclear why giving those numbers (though I understand that you are required to) makes more sense, or is more clear than a description of the patients condition? Some seem to treat it like a stroke screen, where if you have a certain number of qualifiers then your confidence in a significant CVA can be high. But the same weighted value doesn't seem to apply here. And when I say 'seems' or 'seem' I mean that. People that are so much smarter than me that I shouldn't be allowed to carry their bags have been using the GCS for ages and seem to feel that it has value so it's likely that it's my own ignorance that fails to find it good for....anything really. Dwayne

And you even gave me the giant, bold text as a hint that something was brewing! Man...I'm losing it... Dwayne

It appeared to me that the OP was really looking for a physiological discussion in regards to his intubation questions...not advice on when to intubate and why a supraglottal device is stupid unless you can't intubate like an adult... So in response to your question....I have no idea. I love the question but without some refreshing and some research I have no idea. Some of these folks will be able to argue it with you if we can get em pointed in the right direction.. Dwayne

LOL...you are such an asshole... See that? That is why science is good...I let my wishful thinking carry me right over the cliff.... Dwayne

Good riddance to a bunch of nonsense.... Can you site a source? There are some I would like to send it too that have been telling me what an asshole I am for believing such awesome assessment/interventions tools lack value... Dwayne Edited to add request for sources.

I've never used it...It seems ridiculous to me as taught. "Enroute to you with altered mentation, GCS of 9..." What does that mean?? I could understand if you reported "Pt has a GCS of 3/3/3.." but just a sum total seems meaningless to me except for the "less than 8 intubate" crowd I guess.. I can't remember anything about it really. The few times it was required for paperwork I had to Google it. Sorry brother, unless i move to a service that requires it I would have no interest in something that would help me with it. Dwayne

LOL...that is awesome! Love the Timbits! (Though they are evil from a diet perspective) And that couldn't be a cooler name for a kids team! Dwayne

I loved this post except for this. To the first, Why? To the second, I believe you're wrong about that..I, as well as many, many here would argue that men and women are not equal at all...assuming that you can quantify equality with such an equation. Dwayne