Eydawn

Ok then... any exopthalmos? He's got a thyroid storm of some sort occurring. Could have been triggered by any number of things... boyo needs some Lugol's and supportive care at this point. Fluids, cooling, quiet environment, punt to higher level provider than me... It would explain the increased metabolism (can't get full), hyperthermia, flushed skin, agitation, and diarrhea. Wendy CO EMT-B

I've given Diastat before in the group home setting for someone who was developmentally delayed and had refractory seizures... mm, suppository! "Hey, man, do you suppose?? Nah...." Good to know that it doesn't work. I'm printing that study and taking it to the current gig. Got a few diabetics and we have ye old "jelly in the mouth" written as part of our protocol (which I would *never* do, personally as I have no suction available! They're going out on an ambulance if they're that boogered.) Rectal glucose is taught as part of the WFR course (wilderness first responder) for when you have no IV access, and plenty of time... so is rectal hydration, apparently (eek). Wendy CO EMT-B

You said it was a professionally cleaned house... recently cleaned? Exposure to cleaning agents? Just a thought. I'm curious... could this be an atypical presentation of Stevens-Johnson Syndrome? The flushed red skin fits, and if he's got the rare zebra of a lesion on the myocardium, that could account for the chest pain... SJS is associated with antibiotic use, including 'cillins... may be he hasn't reached the peeling skin part yet. (Oh, and I didn't google that, we've recently studied SJS in my nursing pharmacology course.) The diarrhea could be accounted for as a simple side effect of antibiotic use. *Puzzlement* Wendy CO EMT-B

I am interested as to why there is a subsect of militant DNP's clamoring for privileges that they shouldn't have. I am planning to pursue my nurse practitioner at some point in the future; however, I would never refer to myself as a doctor (if I did in fact get the doctorate, instead of the master's) and would not expect that I be afforded the same practice as a doctor. ERDoc- got any ideas on this? What gives? Where did this come from? Is it a regional thing? I'm not hearing/seeing much about it in my neck of the woods, and everyone I know that is an NP practices quite happily as a "physician extender" in collaborative practice with an MD or DO... Wendy CO EMT-B

Is that ethical/legal? Can you intubate someone whose chief issue is agitation r/t mental illness? Very curious as to this line of thinking... to my thinking, RSI is a dangerous procedure with lots of potential sequelae involved with weaning them off the vent later, etc... can you justify it as a provider safety issue, based on those risks? Wendy CO EMT-B

Draw me an otter? Looking for ideas for the tattoo I'm finally getting this summer... --Wendy

Whoa! What, you never seen a caucasian, Latino, or Asian type dude that looked like that? Seriously... I didn't read "black" out of what Mike said, and I grew up in a neighborhood where I was the ONLY, and I mean only, white kid in a 20 block radius. Yikes! Wendy CO EMT-B

I did suggest other things. Support groups. Working in different fields. Finding other means of fulfillment. I'm not trying to be nasty, I'm trying to be honest with you and open your eyes to the fact that you can't just focus on "I want to do this because it helps people" or "I want to do this because it's cool" without being honest as to whether or not those decisions will put the people you want to help at risk. I'm not going to give you false hope, and I'm going to paint you a clear, honest picture. Let me rephrase a bit. I'm totally OK with you taking EMT classes. I'm totally OK with you possessing certification. I'm not OK with you lying to potential employers about your physical status because you think it's OK because it's something you really want to do. That puts your coworkers, yourself, your patients, and bystanders at risk, especially if you're the one driving... If you tell me you have uncontrolled seizures, but you really really want to drive, and ask me if it's OK to lie when you go to get your driver's license, I'm going to give you the same kind of response. I'm not in your shoes. I don't know what your actual, total status is. I want to encourage you to find as much fulfillment as possible, but I'm not going to feed you a happy bullshit line of "sure! Anyone and everyone who wants to should be a working EMT!" beacuse it's what you were hoping to hear... I don't roll that way. I will support you, and help you in any way I can, but I won't ever lie to you. Ask the other folks on the forum about that, if you don't believe me. I really hope you find a way to work in the community in a way that gives you fulfillment. Based on the limited information I have, I don't think it's safe for you to be an EMT in the field. If you want to be an EMT and work as a community liason, in education, etc. that would be awesome! You can offer a unique perspective since you've had to avail yourself of EMS services... it's easier to explain certain things once you've actually experienced it. Hope that helps... Wendy CO EMT-B

If you have a cardiac condition that compromises your ability to perform the physical duties of the job and you have the very likely potential of becoming ill/unsafe while performing the job, I would strongly recommend that you look at a different field... like I said earlier, what about your duty to the PATIENT? You may want to do something more than anything in the world, but if your ability to provide good patient care will be compromised, you have no business lying to screening questions... No offense, but there's certain disqualifying conditions for a reason. There's much better avenues to be useful/helpful in. Think larger! Think broader scope! Different field! But if you have heart attacks a lot and congenital cardiac abnormalities that can't be fixed, why would you put yourself on an ambulance as a provider? I know a gal that fits this description. She's an elementary school para and fiction author. There's plenty of fulfilling avenues in life that won't put other people at risk. Wendy CO EMT-B

I'm hearing CP and SOB, I'm thinking oxygen as a POSSIBLE treatment. It's what's indicated in protocol. It may not be indicated when I actually get eyes on the patient. We'll see. But if it's not high up in my brain, I'm doin' it wrong... Waiting for more patient info at this point. Wendy CO EMT-B

Herbie- I'd +10 that post if I could. Well said. I'm fortunate. Nursing runs in my family, my best childhood friend's mom is an RN and instructor, my husband and brother are both EMTs as are many of our friends... SAR is a family for me... so I have lots of places to let it out and get support. It's finding that support (and not being afraid to use it) that makes the difference between going nuts, or coping and moving forward, I think. Wendy CO EMT-B

Is it possible to get certified? Probably. Is it possible to get hired? Maybe not, depending on the health screening and physical requirements of the agency being applied for... Is it wise, if the illness will inhibit your ability to be a competent provider? Anything neurodegenerative would have to be tread very carefully with... make sure whoever this is (you or a "friend") is taking into account the PATIENT. Not just "I want to do this" but "Is this the best thing for me AND my patients?" Personally, if I knew I had a terminal illness, I'd put my brain to work on other things than EMT work... I'd see as much of the world as I could, and probably work with others facing an early demise... you can do good for patients in many more arenas than EMS, so good judgment is a good thing here... Wendy CO EMT-B

What do you mean, exactly, that ALS boxes don't carry pain management? You guys just don't have any pain management protocols period? I'm so confused. Wendy CO EMT-B

Amen. Well put. Excellent post overall, Steve! So... what do y'all think, to rehash another topic we've covered, about the idea of making sure that you have access to medical interpretation? Should everyone here learn English? Or should we be ready to accomodate any patient? Wendy CO EMT-B

1 C (will you quit changing your darn name?!)- the reason it sums up the sad sorry state of EMS is that it's really basic science that is pretty important to medicine, and yet, someone can practice in the field for 13 years with no desire to learn it (or need to). Basically, it's part of what holds us back as band-aid totin' psuedo-professional public safety kludge-type figures. A good EMS system would require even an entry level practitioner (IV cert or no) to understand tonicity as it pertains to fluid shifts at the very least... hell, how many of our patient problems are caused by fluid in the wrong place, too much fluid in the right place, not enough fluid in the right place, etc? Hypertension Hypovolemia Pulmonary edema CHF Systemic edema Dehydration Fluid volume deficit Just to name a few... and ALL of these would be affected by a provider giving or not realizing they needed to give a solution with a particular tonicity (amount and type o' stuff dissolved within)... Just saying. Wendy CO EMT-B

Mobes- we see people at their best, and their worst. We see the joy, and the grief... and that's part of it. That is a very, very sucky call... and one of the downsides of working remote medicine. I am sorry to hear it turned out that way, and I'm glad you're venting and trying to deal with it. Good job on the RSI save! Atta boy. Dust off, pick yourself up, and realize, no matter how much we cry yes, sometimes God (or however you choose to interpret it, cosmos, fate, flying spaghetti monster) says no and there's not much we can do except keep doing our best. Wendy CO EMT-B

You most certainly did edit out the info about lactaremia and leukocytosis shift. I would like to know, in the absence of a blood pressure drop, how we were to determine prehospitally that this woman was septic without blood cultures? Her rising fever, to me, indicated an infectious process, but I was also more trending along the lines of abdomen-focused infection, as that is where all your s/sx were currently clustered. The CO2 changes are so subtle as to be non-diagnostic in the absence of actually knowing what's going on with her. You knew, therefore your brain went "Oh, it's obvious! So X should indicate Y" when in reality, all we see is Y, with no real idea of the X causative factor... You can get a spiking, high fever with endometritis and PID, as well as with a severe enough UTI (the vomiting made me think kidney infection secondary to untreated bladder infection) that could be secondary to a vag infection of some sort. The lower abdo tenderness and redness to me doesn't scream perforated bladder and sepsis, it says "STD" and/or "vaginal infection" and/or "PID" and/or "untreated bladder infection." There's a reason GYN problems are such a fustercluck. There's too much crap clustered down there that, when affected, presents with some pretty damn similar presentations. I would say the important things for prehospital providers to identify in this scenario are as follows: 1. There is an active infection that is worsening as evidenced by the rapidly increasing fever, pain and redness. 2. This woman needs to be transported for further evaluation pronto. 3. This woman is in a precarious position with regard to occupation and may not be totally forthcoming about pertinent medical history, and needs a nice, safe, quiet room with a social worker or RN that has good patient rapport to ask those questions if we've any hope of getting an honest answer. Forest for the trees, my arse! Things are obvious to you when you know the answer. Sorry, man, but those symptoms don't scream sepsis to me. Especially without blood cultures. Wendy CO EMT-B

Is. Dr. Reyna your advisor? That's who the survey info says is conducting the study... How will this data fit into the larger framework of your thesis? Surely, this survey isn't the only data you will be using? Wendy CO EMT-B

Seriously? The information you've given me indicates need for a full pelvic workup and lab draws. She's got a fever, trending upwards, pain, and indication of infection. I have no idea what hyper-resonant areas mean, as that's not part of my standard physical assessment. So, smartarse, what is it already? Seriously, these signs are so vague/broad as to be of almost no help to the average prehospital provider... Wendy CO EMT-B

Actually, the EMT cert alone won't give you much unless you can explain in an interview how it helped you develop critical thinking skills or some such. Nursing really seems to not care about EMT experience as much... and some nursing instructors view EMT experience as a DOWN check, instead of a positive... Just my experience, as an EMT, in nursing school... Wendy CO EMT-B

What will you do with an English Lit degree? I ask, because my BA is in English. It was cool as heck to study, lots of fun, enjoyed writing and analyzing texts... but I don't use it professionally... Wendy CO EMT-B

Ya know... I actually don't really have a problem with this. Now, before you get all up on me for that statement... hear me out. Would you have been as pissed if they were wearing blue jeans and pullovers? Is it just the dresses that got you, or is it the lack of PPE as a whole? You know insurance wouldn't cover them if this video came out and they had gotten hurt, and I'm sure they were aware of that as well... doesn't look like they put anyone else at risk... doesn't seem any different than any other off the clock "oh man, I gotta take care of this" moment other than the fact that they were dressed strangely. I think they stayed a nice distance back... hell, 'bout what I would have done with a garden hose on a fire, and I don't own any PPE. I do wonder why their bunkies weren't on the truck, but you know, I don't always have my SAR pack with me when I'm driving the response rig in a parade or to an education presentation, either... To be honest? If they had died, I'd have called it an LODD. How many LODD's have we seen directly related to stupidity, where we gnashed our teeth and lamented the idiocy, but granted them the dignity of calling their death an LODD anyway? Wendy CO EMT-B

I disagree. It's a Kickstarter project, and as such, I think it's totally appropriate to post about here. I was going to go look at it tonight because , as I think it's an interesting addition to learning modalities, and now I can't friggin' find it. If you wanted that option as part of your teaching, and wanted to fund the project... or wanted to discuss its merits as he did ask for feedback, now that's no longer accessible. It's an instructor related topic. It also has a plug for Kickstarter. I've funded several worthy projects that used Kickstarter to get their funding- actually, Kickstarter is what gives a lot of things the legitimacy that "hey man, send me money" doesn't. Just voicing m'opinion, as always... Wendy CO EMT-B

Yes, I might, actually. Peds ER at peds hospital = able to take care of high risk pregnancy, right, so they MUST have some adult treatment capacity? Might be good to keep patients together if you can... Would that be appropriate? Wendy CO EMT-B

PAC's?