Eydawn

Well, shit. You don't die from anxiety, so that's not the major problem. Can you give us the hint of how LONG we have to figure this out before the patient dies? Days? Weeks? Or tonight, if we don't get our shit in gear? Full physical exam. Abdominal exam, what's his poop look like, bowel sounds? Aortic turbulence? Vomiting/abd pain? Heart sounds? Discoloration anywhere on his body? Vision/cognition changes that he's aware of? Can he explain why he's fidgeting/moving stuff around? Change in food? Eat anything strange, by chance? Misidentified mushrooms, perhaps (or other local flora)? Wendy CO EMT-B

Get him a gift certificate and take him to a medical supply store where he can buy a good stethoscope that he really likes! That's what I would do... Wendy CO EMT-B

What was he treated with for the SOB? He's not the first one to develop these symptoms, I'm gathering, as his coworkers say the working environment "causes these symptoms"? My first thought was potentially a stress reaction manifesting as anxiety which he is self-soothing with repetitive behavior. However, my hubs, who has the degree in psych (and is also an EMT- *ALSO* immediately said "heavy metals!" So I'm betting he's right. Check at cuticle bases... take scrapings/hair samples, see if you can get it tested... also if there's others who have had/do have these symptoms, be interesting to see their presentation and if they started to resolve or not without treatment... Wendy CO EMT-B

LOL. Y'all are funny! -Wendy

Congrats, Denny! Well done! Wendy CO EMT-B

Whoa. Hello broad question! There's as many answers as there are agencies. Is someone not trading off patient care vs. driving fairly with you? And where you from that you call it a bus, lol? That's mostly the East coast folks that use that one... never heard a Springs person use it before. Crews come in all sorts of numbers and arrangements. Some areas have a medic, basic and a driver. Some use medic/medic crews. Some have a medic/medic/trainee, medic/basic/trainee arrangement... it all depends on where you are... I've seen crews take turns, decide someone drives all day/attends all day depending on acuity of call... etc... why do you ask is my question?? Wendy CO EMT-B

Oh, that was funny as heck. Laffin so hard over here!!!

My two favorite tricks! Human IV pole, and to back up a group, start a roll of Kerlix with one person and have everyone hold a section... insta-barrier! I agree that it usually doesn't have to be a problem. I still am curious to see what Bieber's thought processes are... Wendy CO EMT-B

I'd have to see a physician or PA or NP's state licensure card and it would become a conversation between them and my medical control (as long as they weren't psycho and I genuinely believed they had something to offer my patient. Bieber- you seriously won't let a patient request treatment? We want patients to be their own advocates as much as possible, right? We want them to be educated, and question their care, and understand it so they feel like part of the team and are more likely to comply and less likely to sue, right? Where is that thought process coming from- it's really not something I'm understanding... Dude. You're off inna ditch here. If I'm a severe asthmatic, and I know that I don't respond well to duoneb, and you're hell bent on giving it to me, instead of just sticking with albuterol, I'm going to be one pissed off patient. If I know that I don't respond well to a certain drug, or inquire as to whether you have a drug that I do respond well to (and we're not talking pain related seeking issues here), what do you do, just say "I'm your paramedic and I know best so you shush and let me do my thang"? Now, I can see you shutting down a patient who doesn't know what's going on, and educating them as to why you're making treatment decisions... but a patient with a chronic illness or for whom this is not their first medical rodeo is a whole different story and you better at least be able to empathetically respond to the request and provide good evidence as to why that is not your intervention of choice... Wendy CO EMT-B

Lord, isn't that the truth. You have to play to the test. It sucks, but you have to do it if you want what's offered to you from completing the test.... licensure, certification... you think that's a bad question, try some of my NCLEX style stuff! Wendy CO EMT-B

Mannitol is more easily able to cross the BBB to my understanding, it's a CSF specific diuretic. It's also not easily used prehospitally as you need to have ICP monitoring in place (again, to my understanding) to safely use it... wouldn't we have the same concerns with hypertonic NS if it were also effective in this manner? Wendy CO EMT-B

Limiting fluids... unless you're peeing excessively large volumes every 2 hours, I'd say the need to stay hydrated is a big one, so I'd focus more on hitting the bathroom when/where you can and limiting caffeine... Everyone's body is different. Peeing every 2 hours is not excessive in the slightest in my opinion. That's weird that your FTO even brought it up to you. Having an "iron bladder" is a great way to end up with "oh my god this burns and is the worst pain ever" bladder. Lots of water/good fluids and frequent trips will keep you from landing yourself in lava-urethra land. If you're limiting fluid to the point where your urine is getting dark, instead of light yellow-to-clear, you're not doing yourself any favors. Just my humble opinion (as I go to choke down more Cipro because I overdid the caffeine and forgot to get up to go to the bathroom after fun time with the husband the other night... oh, hello UTI fairy! So not nice to see you again....) Wendy CO EMT-B Edited to fix an accidental triple post... weirdness...

Appropriate in a dedicated medical ministry, not appropriate in our primary healthcare settings here in North America, especially in my geographical region. If/when this individual gets to go do medical based ministry in foreign/underprivileged areas, they will have that prerogative... in a normal employment setting, very good way to get sued. If they want to pray with a patient who asks for it, I see no problem. If they want to pray for a patient who didn't ask for it, on their own time, such as on their break or a short hop off the floor, I see no problem. If they explicitly tell a patient who hasn't asked for spiritual support or who has declined offers of spiritual counsel (chaplain/other visit) that they will be praying for them, that isn't professional nor respectful of the patient. See where I'm coming from with this? Wendy CO EMT-B

Here's the problem- this individual is SO naive that we (instructors and fellow classmates) have had to very firmly reinforce what the boundaries are in several classroom discussions. Don't get me wrong- I *love* that their faith is so passionate. I truly hope it serves them well in their future personal and professional life, and I have every respect for their right to believe what they do. I also worry that they have been so sheltered- they are so religious, that I fear that a serious challenge to their world or a grievous situation will shatter their faith. I've seen it happen before with homeschooled, super religious individuals. This person has made statements in the past of looking forward to providing ministry through medical care to BRING OTHERS TO CHRIST. That was an interesting conversation that this is not appropriate for you as a healthcare provider to initiate... and that ground must be tread very carefully even if the patient initiates the conversation. They didn't seem convinced. They're not very good at picking up on cues when they're making a classmate uncomfortable (and we're not just talking me here, I actually get along with this individual fairly well) and I am concerned, with the risk that introducing religious themes can have with delusional patients, that they will futz a boundary simply because they haven't learned to partition well enough and keep their beliefs in their personal life. Yes, there is a risk with introducing religious ideas when a patient is delusional- that's why therapy units don't play religious focused music. You have to remember that inpatient psychiatric care is focused on people who are so dysfunctional that there is no really other safe place for them at the moment, and their thinking is muddled and illogical. The answer of religion is very appealing in some cases, but our instructors have emphasized that delusional patients can take it too far and slip further into a psychosis, just with a different focus. Hence, my perception of the danger at hand. I have also had experience with another individual, whom I used to manage, who DID cross that line with a dementia/parkinson's patient in our long term care facility... they told the patient that if they prayed, their condition would improve. That was a hell of a mess when the patient took it as implied that the condition was their fault because they didn't pray enough and expressed that when their family came to visit later... I'm just seeing some of the same naivete and lack of boundary awareness, and I'm hoping it doesn't turn into the same kind of situation. We are being tasked with spending 1:1 time with an individual during our psych rotations to practice therapeutic communication, so it is entirely possible that she could provide improper counsel. If it stays on Facebook, in the person's personal life, I have no problem with it... but this person has trouble respecting classmates' boundaries (even with people who share her faith). I will probably bring something up in clinical orientations that is general... or phrased as a question to the instructor about how to discuss religion with a patient who brings it up with you... Just wanted input. Thanks for your responses, folks! Wendy CO EMT-B

Go get em, tiger! --Wendy

I'm keeping this as anonymous as possible, please respect this person's privacy and don't go googling phrases... they're probably innocent enough that they've got their FB wide open for the world to see. I have a classmate here in nursing school, who is younger, homeschooled, and as evidenced by this picture, very religious. We were studying schizophrenia and dissociative identity disorder in class today. As I can't get an image to upload, this was their response that they posted on Facebook (true to word, word for word): Anonymous Classmate: "Thank you Jesus that you CAN cure ANY disease!! With You, no disease is incurable, not even Dissociative Identity Disorder! Our God IS greater! (and I can hardly wait to see You at work in the mental health business...)" Friend's Response (not me): "ohh do tell! That's exciting stuff!" Anonymous Classmate (further explanation): "I am taking "Psychiatric Mental Health Nursing" and we were learning about Dissociative Identity Disorder (formerly known as multiple personality disorder) and my instructor said that there is no cure, and really no kind of therapy...but even if the scientists haven't figured it out, I know that God can cure anything!" As anyone who's studied psych knows, it can be VERY dangerous to bring up religion with individuals who are psychologically unstable, as they can pattern on the religious theme and become hyperreligious on top of other issues... using the religion as another escape, as it were (as opposed to healthy use of spirituality in coping, which is something we've covered a lot.) Should I say something to them? Or let the instructors know that this is their response? I'm really really worried they're going to slip up and do something REALLY DUMB during clinicals. I already fear for his/her ability to get a job and keep one without totally blowing it... I know this person has been sustained by their uber-faith through some of the challenges of nursing school. I don't have a problem with that! They were raised this way, are confident that God will bring them a spouse, etc. etc... but I think this crosses a line and indicates a lack of professional understanding. Thoughts would be appreciated... sorry I couldn't get the screenshot to load... Wendy CO EMT-B

Why are you starting multiple threads? Come back to this one and answer the nice man who asked if English is your first language.... let's start there... Wendy CO EMT-B

Hang in there, Kaisu. Lots of love and good thoughts going your way! Wendy CO EMT-B

Nope... I can piece together bits and pieces... but there's not enough info here. Sounds like they were a BLS crew... sounds like he was very sick... but beyond that? I got nothing. There's weird phrasing in this article. There's just not enough info. I can't even make up a BS scenario that justifies the "abandon woman halfway" and "return to podunk clinic"- those two really get me. The rest of it? Whether or not they provided good care? That's totally impossible to project... Wendy CO EMT-B

What's the age range of your problem students? Just curious. If they're all younger, tell them they're too young to be in EMS if they can't practice assessments on their non-injured classmates. You could create scenarios where the female "patients" have a life threat that needs to be found and provide incentive for finding them quickly... I hate to go this simple, but candy is a good motivator for teaching (as far as I've found)... and if they can't focus, and keep giggling, kick them into the hallway. Sternly. It may mean singling someone out, but the example needs to be set that EMT class is not to dick around in. Just my thoughts. Edited to add: Asked my 21 year old brother (who is an EMT) and he says to hide a $5 bill on the female "patient" somewhere that must be found via doing a proper assessment. They do it right, no giggling, they get to keep it... Wendy CO EMT-B

I agree... when you're newer to your career, "doing the right thing" and "doing what won't get me fired" or "doing what will get me hired" get all mixed up. Paramedicmike- I think this guy's motivations seem OK- he's trying to get his bearings and obviously he knows SOMETHING needed to be done... he's just trying to process where he screwed up and really feeliing guilty because he knows he should have done more. Take my example- I allowed a FTO when I was in a probational employment phase to prevent me from verbalizing important information (observations I had made) in a potentially criminal situation (pediatric death, could have been negligent and prosecutable for all we knew) to the police and receiving hospital staff. I felt sick to my stomach that whole day, it still comes back to bother me that I didn't speak up (even with all facts known, charges were never brought... just turned out to be a very sad situation that never should have happened). I now know, NEVER AGAIN will I let someone keep me from telling the truth. I was young (er). I desperately wanted to work prehospital EMS. I was trying to fit in with an agency that I really and truly did not fit into well. Part of that is that I didn't know as much about working with people then as I do now, part of it is that our approaches to care were so different (at least, between myself and the FTO's) that it just wasn't going to work out. I thought about the medicine too much. (Direct quote.) Did a patient directly suffer harm due to my actions or inaction? No... but there were other things that I saw that weren't right, and I learned to shut up if I wanted to stay employed (until it reached a point where we mutually decided that this employment encounter just wasn't for me). Sometimes, you just have to stand up and do what's right, and sometimes, you don't learn that until you've epically screwed up and you know in your heart that you could have done the right thing. Move forward from this. Realize that there are always other employers, (even in a bad economy) and that caring for your patient is your number one priority. Be ethical. I bet you won't let another situation like this past you- if you do, or you start to become complacent with "well, it just wasn't my problem, it was the other guy's deal" then you need to take a good hard look at your motivations and get out of dodge before you really do kill someone. We make mistakes. It's how we respond to those mistakes that speaks to our character and our ability to be excellent, compassionate providers-- or not... the choice is ours. Wendy CO EMT-B

Mm, if you've already got a POTENTIAL allergy issue, with histamine release and all that, wouldn't giving an opiate not necessarily be a good idea? (Am I off in the ditch with my understanding that opiates can cause histamine release?) Plus, don't you only administer opiates to help with anxiety when they also have concurrent pain (AKA chest pain) and you're treating the pain to diminish the anxiety? Unless she's got a pain source, you'd have to come up with a really good reason for having given a narc, right? I might consider a benzo... very low dose, not wanting to increase sedation too much in case this really is a zebra monster getting ready to pounce on us... hm. Never thought of that angle before. Wendy CO EMT-B

It's now locked down to invitation only. I tried to access and can't, and it says contact the blog author. Bummer! Wendy CO EMT-B

Then what in the bloody blue flying Freak Brothers did you apply to Rural Metro for? LOL! Dude. Aurora Fire has medical control, nontransporting ALS fire department, and Rural Metro butts heads with them hard core. At least, that's the way it's been ever since I've been aware, and I did my clinicals with Rural Metro. If you're living in Parker, have you looked at Colorado Springs AMR? Really not that much further of a drive if you think about commute time through Denver to get up to Boulder/Longmont for Pridemark, which I see you've applied to already... there's Action Care (Action scare)- but they're primarily IFT. I don't know what Castle Rock's gig is... Looks like you hit most of the major ones, IMHO. I'm more familiar now with the folks up north, as that's more of where I am... if you wanted to drive to Northern CO, there's Thompson Valley in Loveland and PVHS in Fort Collins/Loveland (who's hiring for FLIGHT if that would float your boat, application pool currently open...) Good luck to you! Got your CO cert all taken care of? Wendy CO EMT-B

OH. Oh my God. Now, first of all, I wonder just exactly what those special circumstances were. Second, NO, no sane woman would ever put bacon in her vag. Just saying. We send people to the looney bin for putting odd objects in that orifice... were I doing an intake assessment, bacon tampon would be an automatic criteria for "private room admission ASAP" and a call to pharm for some stat Diflucan... @_@ Bacon is kinda...sandpapery... ya know? (Shudders) Wendy CO EMT-B