Eydawn

My dad grew up there! Never been there though. Let me know when you hit the Western type area ;-) Wendy CO EMT-B

Wow! Okie doke. This changes things a tad. First off, thanks for bringing us this scenario. We don't discuss OB related stuff as much on the City, and it's good to shake our brains a touch. Could I try to explain something to you? There's a huge difference between medical professionals/students presenting each other with case scenarios (AKA: I saw this, I did this, this is what I thought, and this is what it turned out to be) and using scenarios in which you were actually the patient. When you're the patient, all of a sudden, there's this huge bias in what you're presenting whether you want there to be or not. For example... I have pretty wicked asthma. When I worked at the Boy Scout camp in '06, I was not real compliant on my meds, and there were a LOT of allergens/stressors. I had a few wicked attacks, treated by my coworkers (I was a medic on the ranch). My memories of those nights are not clinically sound. I felt like I was dying. Was I? No... because nobody called the local crew (with their entire ONE ALS intermediate guy) to intubate and transport me. Was I pretty nunngered, to use Kiwi's phrase, for a while? Sure. But not dying. There's a reason I don't use those calls directly when I'm discussing respiratory issues on the City, nor do I present them as case studies of people whose care I was involved in. Do I know a lot about what went down? Sure. But I can't remain objective on it, no matter how hard I try. We're really glad you're just looking for a "well, what would others have done with this" sort of deal and not looking to sue... we've had people come in and misrepresent themselves before as students or providers, only to be lawyers or aggrieved patients looking to get evidence to build a case. The biggest thing we're missing, in what you presented, is actually having been there ourselves providing care. I can tell people that I thought I was going to buy a tube, but I can't tell them what my clinical presentation was, my skin color, my work of breathing, my sats, my vitals... what kind of status I was really in. Was I stable? Was I unstable? Only my three guys that were taking care of me really know. Point being- it's different to try to retrospectively analyze a call that you were providing care on, or were presented from another clinician, than it is to analyze a call provided by the patient (especially if that patient is not in fact a medical provider of some level). So, short story- thanks for playing with us! We can't tell you how stable/unstable you were, but the call was interesting for us to look at! Wendy CO EMT-B

Wouldn't V-fib be irregularly irregular (gosh that double term makes my brains itch)... it's all over the place... Thanks on the Dubin rec, I'll be looking for that for sure by the time we get to the harder stuff... Wendy CO EMT-B

OK. I got another one. Did she by any chance need blood products while she was in the hospital? Because... (Zebra music please)... I just learned about a condition called TRALI- Transfucion Related Acute Lung Injury, whose seminal symptoms are dyspnea, hypotension and fever... I know it's a wild hair, but DID she get blood products? Could this be our zebra? Wendy CO EMT-B

Why do you want to avoid cannulating the kiddo? Just curious. Wendy CO EMT-B

Lifting varies... seems like every time I go to lift with what feels to me like moderate weight, moderate reps, I'm sore the day after and it sticks around for 3-4 days. Often = nada right now, as every time I go, I get knocked on my buttski and then don't want to do ANYTHING fitness related for the next small while. I think the supplement is getting sent my friend's way... he uses it and likes it. I may look into getting a protein powder that is just that- protein... one of the hippie ones like Sun Warrior or something... no creatine or unpronounceables for me! I actually did some more research after posting here and damned if a pounding, nasty headache isn't one of the most common Q+A topics on weightlifting forums, and it's all guys who started using creatine... it dehydrates you quickly, apparently. No thanks! Wendy CO EMT-B

Hullo? She's sinus tach (assuming till strip is provided) in the 200's and severely SOB... I'd call that immediate threat to life, there... especially being post-surgical and at very high risk for PE not only due to surgery, but because pregnancy and labor mess with clotting factors... Wendy CO EMT-B

Hey folks... anyone have any suggestions for dealing with delayed onset muscle soreness? I haven't lifted consistently since high school (bad Wendy...) and when I go to lift now, I end up with debilitating soreness that knocks me off the training wagon for varying lengths of time. The soreness also makes it hard to do my job sometimes! Yes, I know I should bring it up with a doc, and yes, will do when I have my annual physical next month... but until then, any suggestions/ideas? Also... has anyone tried the South Beach eating plans? Night shift and school and stress have wreaked havoc on how my pants fit. I'm trying to find something that works for me... and I know everyone is different, but I wondered if anyone had experience with South Beach (not Atkins) who would be willing to share... One more random- has anyone ever had a migraine triggered by a protein powder shake? The one I tried the other day had creatine in it, and I wonder if that was the culprit. I seldom get migraines- have had maybe 2 hormonal related, one med reaction (macrobid), and then this monster... I don't know if it was too little sleep/run the 5k/too much coffee, or the shake, and I'm nervous about trying it again... Ta for now... Wendy CO EMT-B

Howdy y'all... For this level of my nursing course, we're dipping our toes ever so gently into the EKG interpretation waters. The "oh shit!" rhythms are no problem... (V-tach, V-fib), PAC's and PVC's are easy to see, counting the little boxes is nice and simple, and we don't have to know any junctional rhythms or blocks just yet. Where I'm getting tripped up is interpreting whether a strip is A-fib or A-flutter, as they appear very similar to me and discussions I've had in the past lead me to believe that some docs use the term interchangeably, as the patient treatment regimen and prognosis don't change much based on which you're seeing. Do you have any suggestions as to how to definitively interpret one from the other on an ECG tracing? At least I wasn't my classmate, who posted up about a totally normal sinus rhythm desperately trying to figure out what was wrong with it... (I wouldn't normally be snarky about a classmate making a mistake, but she's the superachiever who's in it for herself and nobody else, so it was amusing to see her step on her own foot a bit.) ;-) Wendy CO EMT-B

I would also want her transported to somewhere with surgical capability. The progression of symptoms here and the significant neuro damage that has already occurred leads me to think "bleed" instead of "clot"- stroke center with no surg suite can give TPA/similar but that's useless here. Odds are she's fairly toast as it is... it seems that this was fairly sudden onset, so acute subdural or subarachnoid are where my brain wants to go based on my past patient experiences. Quite possible she fell and didn't tell anyone- that was always my absolute favorite... Wendy CO EMT-B

Kiwi, QUIT BEING AN ASS. Not everyone uses the same number system for reading BGL, and 38 in common American usage means HYPOGLYCEMIC. Until you plug in and do the conversion to figure it out, you have no way of conceptualizing just how high that "38" is in the numbers you're actually used to. THAT is why D50 was suggested. It is also still currently used here in my neck of the woods in both the hospital and pre-hospital settings for different patient presentations. BACK OFF, yo! Thanks. You also jump way too fast to advanced airway management here. She's breathing at 38, she's satting high 80's, we need to assess for aspiration first before we jump for the damn paralytics. It occurs to me, that if she's in DKA (which this appears to be with acetone breath and sky-high BGL) that the high respiratory rate may be the compensatory mechanism to fight the acidosis... so perhaps we should think about administering bicarb (off the wall guess here, as I don't actually know, but I do know we need to fix the acid-base balance) before we knock out her drive and try to take over... Was she diagnosed with gestational diabetes, perchance? Folks with that diagnosis often then go on to develop Type II if not carefully watched/managed (it increases your risk substantially). That is my index of suspicion for what is happening here... As far as baby goes, definitely get IO access and start some fluids... also see if orals can be tolerated... I would go for formula if possible, as H2O isn't well tolerated by infants this young... mom's definitely the priority, but baby isn't far behind with that elevated pulse and skin turgor... dehydration kills babies every day around the world, and kiddo's kidney function is at risk if diaper is dry and baby's that fluid volume depleted. Bear in mind, if baby's that dehydrated and ends up vomiting, then you have two airways to be concerned about... Wendy CO EMT-B Edit: Darn thing turned two separate posts into one and looked super weird. Fixed that.

I'm guessing she's both septic AND threw a PE. Both common complications post-surgical, and would explain the gasping for air and high fever... I would really like to know her BP, and if she's been d/c'd on any medications and if she's been compliant with those meds, given that she was diagnosed with HELLP. I am curious as to whether she actually had pre-eclamptic signs, or was just exhibiting more of the HELLP spectrum... it's all moved around so fast nobody can keep them straight anymore, but I'd like to know if her disease state affected her BP or her liver more, essentially... What's her vaginal discharge like? Any indication of birth material retention? (Rare, but could occur, even with a C-section). What's the monitor look like? Neurological status? Wendy CO EMT-B

Oh Jesus. I lived this scenario back in August and nearly got fired for telling EMS the above requested information of number of patients, how sick, onset of cases over time, etc. (My former administrator was a nutter butter who didn't understand medicine very well.) I now work somewhere else, in case anyone's curious... So, waiting for the info that others have requested... I would add, any indicators that anyone's aspirated, and are there any folks with moderate-to-severe dementia who are infected... Wendy CO EMT-B

Here's what Doc meant to say and how they should have written it: "The patient has been hospitalized and is now potentially nearing discharge. Patient will be continued on IV antibiotics one more day; we will consider discharging her tomorrow."

I don't get the nurse vs. paramedic thing, I really don't. I've had to fight (hard) for the EMS side of things and bring perspective in my nursing classes... the sad part is, a lot of my instructors just plain don't understand what EMS really does. And they don't care to, in some cases, either. How similar our jobs, in many ways, but how different the viewpoint... if only EMS could start to understand the continuing care part of things, and nursing could see that really what EMS does is fast triage/treat, focusing on immediate stabilization... alas, I wish for a perfect world, haha. I would comment on the original topic, but my current gig-for-hire is long term care night shift... so not really EMS related. My not-paid-EMS-related-gig is Search and Rescue, and what I love about that is the challenge of managing patients over several hours, sometimes in remote settings. I actually really dig interfacing with our local EMS crews; I often end up being the one on scene who does a lot to try to make things run smoothly as far as interfacing with the crews goes. I also really dig the public education side of things... "Hey kiddies! What do you do when you get lost?" What I hate about SAR is recovering dead bodies outta the boonies, especially suicides. And there's always politics... but where is there not? I also hate not being able to respond as much as I'd like to (hence the scheduled public ed side of things). Oh yeah! And everyone's got that one (or two) coworker who thinks they're God's gift to XYZ, right? Man, I got one of those. *sighs* Could do without that one... Wendy CO EMT-B

I don't agree with drinking to the point of blacking out, or till vomit-R-us... but I do think, at least for me, part of my brain engages when I've had a couple drinks (or quits interfering with itself) in a way that allows me to think about things in a way I normally wouldn't. Almost as if my brain is too on, or something... not quite sure how to describe this to be honest. I also, however, fully agree with anyone who chooses not to drink. Your life, your brain, and nobody should hassle you about it. I didn't drink until I was 22, really... spent most of MY undergrad years watching others vomit at 3am on Saturday morning... (ye gods, I should have charged instead of doing that for free...) Wendy CO EMT-B

Mm. Personal? Sure. But it appears to me that this individual has what none of us does- direct, personal experience with Kiwi, in person. Regardless, I think we all know where this goes... you never really know someone from the interwebs the way you think you do. Shall we move on? It has been pretty firmly established by Kiwi himself and others that no, he is not a prehospital provider. As I said early on in this thread... if you bullshit, apologize, start over and we move forward. Wendy CO EMT-B

You'll notice that it is a moderator who is doing some of the inquiry. Thanks for the 64 point font, Richard... I think this is a valid discussion string that needs to be looked at further before it is locked. Apart from all the pissing about the OP, it has now turned into a legitimate seeking of information about Kiwi's status, due to some obviously not limited confusion. Wendy CO EMT-B

Now see, here's the funny thing. I also was under the impression that you were or had been a practicing prehospital provider. Seriously, bro, most people who don't have rig time don't muck about and clearly state that they do standby, or wilderness, or industrial, etc. Seems to me all you've done then is some volunteer 3rd rides... correct? Funny... that people on an EMS forum, who listen to you talk about EMS encounters, and who participate in EMS scenarios that you create, should assume that you were in some way actually a part of EMS. Especially since your screen name is KiwiMEDIC. Kind of disingenuous not to let people know to NOT imply that you were in fact an EMS provider. Does it make a difference? Well, yeah, it does. This is a professional forum for medical providers, and your contributions take on a different meaning in different context. As far as the medicine goes, you've got some solid science understanding under your belt, but no real practice then. I no longer empathize with your kvetching about first semester nursing school, as you've really no right to be frustrated... you really and truly are a n00b, and should assume the humility of such, or you're going to get your ass handed to you spectacularly by your course coordinators and clinical proctors. I speak from experience- come in too strong, with or without knowledge base, and you will be a very, very sad camper until you figure out how to play the game... As far as the intelligibility of your recent posts, I've gone so far as to wonder if you're posting under the influence of some kind of substance sometimes. You write very fragmented, flighty things... go on jags of derailing threads with bullshit... and generally muck about. Most of your posts I can read... but there's been SEVERAL recently where I couldn't figure out what you were saying or getting at. To wit: The first post you made in THIS thread. It's not the language barrier, it's the writing itself. My brain/ear can handle weird local vocab and phrasing; I grew up reading British popular literature... NZ isn't that far off as far as the written goes. The language thing was funny in 2, or even 3 threads... but it's crept into ALL of them, as if that's the only thing you can talk about right now- your language differences. TBH, I'm not pissed, I'm just kind of sad really. Omission is just as shitty sometimes as creating elaborate lies... I thought you were a different person than you've turned out to be, so I am disappointed. I don't think you're a crap person or anything, I just think you could have presented differently and been more overt about your current status in the world of medicine, instead of just letting us all make a natural assumption and playing with it. Wendy CO EMT-B (in the spirit of disclosure, currently expired and in my grace period, but it will be reinstated prior to June this year)

Wishful-Darwin calls... I've got some decent SAR related ones... Well, we had a guy decide to go freeclimbing on a local natural feature, stoned... fell about 35 feet down. Already had his pain control on board, man! Same area, different natural feature... group of young guys without shirts... and one of them goes hopping along different rock bridges, only to fail and find the bottom of the falls with his FACE... and then his buddies carried him 40 feet (yeah... so much for C-spine) before someone witnessed what was happening and called in the pros... Neither of these young men suffered any permanent harm fortunately, some serious injuries/fractures that both ended up healing fairly well from... but it was definitely a couple of head scratchers! WTF, guys? Wendy CO EMT-B

As stated, this is not a HIPAA issue. You do, however, need to look at your company policies and see what they say, if anything, about a scenario like this. Wendy CO EMT-B PS- what IS a HIPPA, anyway? A female hippo? ;-)

Pardon my thread tangent for a mo' folks.... Kiwi- stop pissing in every single thread you post in wouldja? It mucks up the folks who are actually trying to follow what is going on. You are a funny fellow, but howsabout you go a few posts where you don't have to return to explain you were once again "taking the piss" hm? Lots of love, Wendy Now, as to antibiotic selection... what kind of oversight have you remote guys had? What kind of antibiotic specific education? Or are you just the "hands" giving it out with direction/approval from the "brain" doc overseeing you? Just curious... Wendy CO EMT-B

What, you mean like the program that my community is just starting up? http://www.coloradoan.com/apps/pbcs.dll/article?AID=2012202100337 Cheers... Wendy CO EMT-B

Sending prayers and good thoughts your way. Hope things turn out OK.

Using anyone for target practice = poor taste. There, now I called you out too, lol. Shamelessly redirecting to the new thread I created: http://www.emtcity.com/topic/21493-recognizing-your-own-bias/page__pid__276144#entry276144 Shall we let some of these other threads go back to their original course, and corral all the ethical, philosophical debate into one arena? Wendy CO EMT-B