Eydawn

http://www.msnbc.msn.com/id/40715888/ns/politics-capitol_hill/ Pretty interesting moment in history. One akin to having homosexuality removed from the DSM, in my opinion... I personally don't care who's interested in whose bits as long as they're a good soldier! Wendy CO EMT-B

Right now I'm sitting here craving oysters and lamenting that I don't get paid until Monday, because I could totally go for the $1 happy hour oysters at a local restaurant. Do y'all like oysters? I think they have a wonderful, weird texture and flavor... I hear you're either into them or not... I could eat shrimp cocktail until I popped. I love crab legs, drenched in butter. Mashed potatoes, oven roasted wedge potatoes, roasted beets, roasted asparagus... totally on a roasted veggie kick right now... Pad Thai noodles, Udon soup, edamame... loving the Asian food too! So what are you guys eating? Or wanting to eat? Anything that's just totally kicked a craving for you lately? :-) --Wendy

The difference between transporting and working a pediatric code and transporting and working an adult code is that peds are much more resilient and research has shown (last I read, anyway) that there's a greater chance that extended working on a peds code is much more likely to result in resuscitation. Obvious dead should not be transported, ever- peds or adult. The problem with transporting adult codes is that it is definitely hard to perform CPR on an adult in a moving vehicle... it's less safe for the responders, and if the risk/benefit ratio isn't great enough, it shouldn't be done. The peace of mind thing and the false hope thing are borderline in transporting adult codes... sometimes it's better for them to get closure from ceasing everything in the field. Just my humble opinion... Wendy CO EMT-B

There are two ways to look at this. 1: She's empowering herself by attempting to benefit financially from her once-in-a-lifetime experience, and by doing this she is breaking free from the traditional molds of society where sexuality is either licit or illicit. 2: She's devaluing herself by commoditizing her sexuality, and is little better than any other whore who sells sex for financial benefit. I'm halfway between the two. It's her body, and she has a right to do whatever she wants to with it, as long as she's found some way to make this "transaction" legal. But, I think she has not thought through the emotional and potential physical consequences of sexual interaction in this fashion. For example, is she planning to have her partner screened for STDs, or is she going to take the $5 mil HIV risk? I wonder how she feels about sex in general- the first time is usually not as enjoyable as subsequent times, and instead of finding a partner she connects with on the emotional/psychological level, she's going for a wallet. What if her partner is extremely unskilled, or hurts her intentionally? How will that affect her future sexual interactions? She's worth more than her coochie... I hope she realizes that fact. I do think that putting yourself out as a sexual partner for financial gain does devalue you in some way... but how individual people react to that varies by the person. Also, why are we still perpetuating the idea in our modern society that virginity somehow denotes value? Why is having sex with someone who's never had sex before so important in a society that doesn't value the "first born" in nearly the same way that progeny were valued in the Middle Ages? I was a virgin before I had sex with my husband (but was not married to him at the time I lost my virginity), and he's the only man I've ever had sex with. That makes me an oddity, it seems, in our society... but I don't value my husband any less because he had a sexual past before meeting me... No easy answers here. Wendy CO EMT-B

The perspective of a student type... What I find useful from a preceptor: Engaged discussion, an accurate review of performance, enough space to develop my own comfortable system with critique to improve it, someone who's not afraid to totally check me when I'm about to do something dumb. Poking me to think more about the pathophysiology is great! Allowing me to put theories and connections out there without being chastised is also nice. Teaching me to develop good working relationships with a variety of personalities. Someone who isn't afraid to ask me what my learning style is and change their teaching accordingly. What I do not find useful from a preceptor: Someone who's hell bent on making me learn their way because it's the ONLY correct way and marks me down for not thinking/acting the exact same way (no Mini-Me attempts, please), someone who doesn't care to engage with me or actually teach me and frowns upon independent thinking. Someone who doesn't understand the concept of a learning curve. Emphasizing short scene times above good care. Does this help at all? This was great for me to think about, as I'll be in nursing clinicals soon... when my preceptors ask me what they expect, I'll be able to think back to this! Wendy CO EMT-B

You're right. I tore him a new one. I have a very small tolerance for ill-written paranoid ranting and careless accusations with no basis in fact hurled at respected members of this forum who participate very well and actually bring something positive to the experience here. Sorry, I called him a 'net whacko because I call it like I see it. My father's gotten death threats from folks on the Usenet before, and the there's really good markers to identify whackos by, and darned if I'm not seeing some of those here... not saying that Lifeguard here would make death threats towards anyone, don't get me wrong... but I've seen this kind of pattern before too many times. Come in, make a mess all over, and generally provide a good example of trollage-- get called out by those who actually care about the quality of posting here. Futile to argue with, better to quash and have done with. Is it kind? Nah, and trust me, nobody LIKES being nasty to trolls... Is it necessary? Only in severe cases. Which this most definitely is. You know me, Ruff- I'm usually the one trying to mediate and bring in more discussion... in this case, I specifically chose not to, and refuse to apologize for that choice. Wendy CO EMT-B

Hey there... since there's so many of us here that have had a variety of different textbooks, I would like to ask what your recommendation for a good pathophysiology textbook to use as a reference would be. My class used Understanding Pathophysiology by Huether and McCance Mosby 4th Edition © 2008. I HATED this book. It did not explain things well, it relegated explanations of some important concepts to little text boxes or charts instead of explaining it in the text of the chapter itself, and all around just was not very clearly written IMHO. As soon as I take the final tomorrow, I'm selling this bugger back. I do, however, want a good patho reference to use while I'm in nursing school, and I know this isn't the one I want. Especially you educator types... what texts would you recommend? Thanks in advance... Wendy CO EMT-B

Look here, my friend... we don't give out negative points because we don't like you, we do so when you appear to be a friggin' troll! I read through all of the threads you posted as you posted them, and you rambled all over the place and made a mess in here. I'm sorry, but you then lashing out and calling people paranoid (with a definition no less) just makes you look even dumber. You're an internet whacko, and were summarily labeled as such by those experienced in identifying them. Congrats, you got your money back. Sorry you got screwed by the strike because you happened to be going through school at the same time that the strike happened. Can you shut up now? Please? Even more telling is your need to come in here and flash around "oh lookee lookee I got my money back you all were wrong" when it really serves no purpose. Or, even better... can you start posting on the clinical threads and actually PARTICIPATING in this forum instead of being wrapped up in your own little world all the time? There's a whole wide world of medicine out here, and all you want to do is piss and moan about how your clinical situation sucked and how some of the big bad mean Canuckian members here decided they didn't like you... Thanks. Wendy CO EMT-B

I would like to call attention to the fact that cumulative trauma exposure can in fact increase the risk of adverse psychological effects... "desensitization" is bullshit, IMHO. When you're busy dealing with a shitty scene, you have to compartmentalize your emotional reaction away from your thinking self for a while... you shut down your reactions, finish the job, and then process the call later. This has a natural kind of sequence to it- go on call, realize call is shitty, defer reaction, process back at station (or for the next few weeks, etc.) Pictures out of nowhere showing violently abused children and all variety of death and dismemberment? What's the purpose of subjecting people to that? The truth of the matter is, you never know how you will react to the actual scene until you're in it. And then you deal with it. Showing a group of people every nasty picture imaginable will not only NOT "prepare" them for reality, but will possibly make things worse- see my opening statement... My major question is whether the coroner warned the class that the slide show would be extremely graphic. No warning? Stupid educator. Appropriate advance warning and explanation of why the images where chosen? More appropriate... yet still questionable if there's no other purpose than to "show you reality." If there's something to actively be learned and the pictures were presented with an explanatory context, then it would make more sense (e.g. how to recognize physical abuse, how to recognize a crime scene...) I'm with Mobey on this one, especially with regard to understanding psychology and the fact that these students probably weren't presented with any psychological education to help them understand their reactions to these photos... Wendy CO EMT-B

Those who went better come back and tell us how it was! I couldn't have afforded it this year at all... makes me sad, I really want to go one of these years. Maybe next year? :-) Wendy CO EMT-B

Addb raises an excellent point! You may simply need your ears irrigated from a wax buildup, or you could be starting to have some baseline hearing loss. A hearing test is an excellent thing to get when you first get into the field, so that you can show progressive loss from work exposure... Wendy CO EMT-B

How do you learn? Are you a visual learner/prefer to read material? Do you perform better on tests after taking similar tests repeatedly? Are you good at standardized tests? Are you an auditory learner? If you prefer to read material and do better after taking practice/similar tests, I would say buy the workbook. Take the first test in it, see what you missed, and re-read that material in your textbook until you know why you made the mistakes you did. I would recommend this especially if standardized tests are not your strong suit- it's about knowing how to take the damn test as much as it is knowing the material. If you prefer auditory, sit down and read through your text with a classmate or friend and explain the material to them. Have a classmate explain key concepts to you. The most important thing to remember is on any question, if scene safety or airway are listed and could be correct answers, they ARE the correct answer. Scene safety and airway always come first. That's what throws a lot of people- they actually start reading into the scenario and formulating how to treat the patient, but the question asks "what's the first correct action" and it's not already listed that your scene is safe... again, it's about knowing how to take the test... Wendy CO EMT-B

Dwayne- there's simply not enough information to go on here. He was feeling sick, his wife was already taking him to the ED... unknown patho on what was really making him feel sick in the first place and no prehospital tests or indicators in history given that could really lead you to the "aha! (maybe?)" moment, as far as I can tell. There is no "normal" for someone in their 90's. Trust me on this! There is normal for THEM.... but a true norm? I'll believe that when I see it. There's so many factors that go into vitals for the elderly, including polypharmacy, past history, lifestyle for 80+ years, work exposures, what they ate yesterday, how much they slept (if at all), have they pooped in the last week... it goes on and on here. Without a 12 lead in front of us to actually look at, no way to really know if it was cardiac (which is my suspicion, based on the nitro hx) when it could have easily been neuro, or metabolic... there are so many things that go wrong that make our elders feel "weak" or "sick" and without a detailed history from the past month and knowledge of all his prior conditions, there's no way to tell what he was dying of. Sometimes, even when you have all that info, you still can't figure it out (you meaning both prehospital, me, in my facility where we care for them before we send them out with you, or the hospital itself...) I agree that to just assume that someone is old and dying is foolish, but, nobody is JUST assuming that- it is just one possibility in with many others. Sometimes they just freakin' die! It happens. The fact that he was admitted to the hospital indicates that there was some kind of issue that needed medical monitoring, but without the chicken, so to speak, (AKA what he was admitted and monitored for) it's hard to look back and see exactly what flavor egg might have been lurking while you were transporting the guy... I think the major issue here is that these classmates of Viking's are assuming that because the patient died, there is something that could have been detected by EMS that was missed. This is an erroneous assumption, and while criticism and self-examination are great learning tools they need to be used appropriately. It's not about "he died so you must have missed something" but rather should be more along the lines of "hey doc, do they know what that guy was admitted for and how he died? Ok, let's look back at the call and see if the evidence we saw points in a different direction now knowing this info..." I think it's the approach more than anything that people are irked about here. I'm interested to know why he was admitted... but sometimes you don't get to be privy to that info. Pity, because it robs you of great chances to learn more about all this... Wendy CO EMT-B

Damn, Mobey! Could ya have been a little harsher there? Cutie- listen to what he says. I also had to read your post a couple of times to figure out what you were saying... if you don't spell things correctly and write with some semblance of grammar, people will automatically assume that you're stupid. Sucks, but that's the nature of the 'net. As far as hypothermia and jostling your patient, I believe the answer you are looking for is V-Fib (someone correct me here if I am wrong) because the conduction pathways in the heart go all wonky and the AV node doesn't conduct correctly due to inability to depolarize properly, leading to quivering-bag-o-jello heart. Jostling your patient causes stress and a sympathetic response, which speeds up the heart, which leads to the above mentioned effect. You said it was for a review sheet- what do your source materials say? What are you studying for? Wendy CO EMT-B

Look, maybe SJA doesn't want you, but that doesn't mean there aren't volunteer first responder options for you! Look around. Maybe Boy/Girl Scout equivalents, where you could go on camp-outs and provide first aid? Or teaching first aid and CPR? That's how I cut my teeth... And also, your mental approach to any problems you have will have a HUGE impact on your actual experience. Wherever God closes a door, somewhere He opens a window (When one entrance closes, look for the other avenues, for the atheist types). I was crushed when my first attempt at working prehospital crashed and burned- but in hindsight, not continuing to work for that agency was the best thing that EVER happened to me. It taught me VALUABLE lessons that I will take through my entire medical career. Maybe this is a blessing in disguise, even though you can't see it right now because it hurts too much. As far as your physical stuff, if traditional approaches are not helping you, why not try some alternative therapies? Hell, if you have nothing to lose, it's worth a shot... and the threat of a wheelchair to me would be equivalent to "nothing to lose." Good luck to you! Chin up. Wendy CO EMT-B

I have a lot of good ideas, especially since I currently work in long term care and have to interface BOTH with the ED and EMS on a fairly regular basis. However, I am in the skeptical camp- I do not give permission for citation unless I know where my words are being used. So, once you come back and post what you're writing, who you're writing it for, a contact for you that includes your real name and what publishing authority you will be using, then I shall spew forth with my ideas! Wendy CO EMT-B

Sure. The Littman didn't fit as well in a pocket, the earpieces came off easier which is not good when you're trying to pull it out to get your vitals (I actually thought I had lost one for good at one point until I found it under the captain's chair), and I heard a lot more running truck noises that muddled the sounds I was actually trying to hear with this scope. In a quieter setting, like a patient's house or a clinic setting (in my Boy Scout stuff, for example) I can hear breath sounds better and distinguish between them better with the Littman Cardio II. My cheapo $10 double bell is very resilient, tucks neatly into my pocket, doesn't fall apart if it's not treated nicely, and didn't pick up nearly as much of the truck noise. I could hear BP's without added distraction with the cheapo, and while I couldn't hear breath sounds overall as well as I would have liked, I also didn't have as much interference to wade through. For a non-field setting where noise and being brutal on it aren't concerns, I much prefer my Littman Cardio II. If I'm out in the field where I have to stuff it into a BDU pocket and play with diesel noise, the cheapo works just fine for my purposes, especially since I'm a Basic and when I was in the field, nobody gave a rat's butt what I could hear as long as I got three sets of vitals... but I digress... Make sense? And again, I think it totally depends on the person. Some people will prefer a higher sensitivity scope in certain applications and vice versa... Wendy CO EMT-B

My mother in law bought me a Littman Cardio II a couple years ago for my birthday. I can definitely say in my personal experience, I heard breath sounds and BPs better in the back of an ambulance with my $10 cheapo that I won for getting the high score on my first responder exam, way back when I was 16. However, in a non-ambulance setting, I MUCH prefer my Littman. Love my Littman Cardio II. Love it. It's totally reliable, but definitely not the best in the back of the rig. I'm going to LOVE it for nursing school though. HOWEVER- You hear what YOU hear and you know what you like to listen through better than anyone else, they're your ears, after all. Pay attention to that; stethoscopes are like boots, everyone has their preference, and what works for some people does not work for others. If you have the cash to drop and that's what you really feel like spending it on, who are we to tell you not to? Do, however, pay attention to the consensus here, which is that less sensitive scopes seem to perform better in the prehospital environment. I wholly understand wanting to get a quality scope, but there's definitely value in getting the appropriate quality for your environment. For example, in the electronics world, you don't necessarily need a $600 Fluke multimeter in your garage when the $40 hardware store brand does everything you need it to and doesn't have a bazillion functions you will never need... now, were you an electrical engineer working in a high-tech clean room, yea, the Fluke would make sense. Hope this helps! Wendy CO EMT-B

Officer's first mistake: The second he got within visual range and could see a tank and a cloud, he should have gunned it into reverse. Second mistake: Actually entering the cloud of vapor. This was too sad to watch... made me cry. I thought LEO's had the same kind of scene safety training that we all get on day 3 of EMT class? The rule of thumb and all that? I could swear all the cops I know have had at least that minimum of training. Fire department's major mistake: Parked WAY too close to the scene. They should have stopped at a much further distance back. Once they determined wind direction and substance, they could have entered the "hot zone" with the apparatus to use the water... but they shouldn't have darted right in like that. Sucks all around, here. Lots to be learned, unfortunately, but at way too high a price. Wendy CO EMT-B

Here's the part you must keep in mind: The patient has a right to decide whether or not to pursue any intervention, no matter how old they may be. If she is cognitively still there, and can still get around with a walker (even needing an assist), and has chosen to go through with this surgery, neither you nor I nor any other person has a right to say "oh, this poor woman, she's just needlessly prolonging her existence in a nursing home." Empathise with the pain she is about to go through, but do not judge her decision. If she is still her own guardian, she had to consent to the surgery; if she is not, one can hope that the POA abides by her wishes (which many times, most do in my experience). Quality of life is determined by the person living it, not by anyone around them. Even in the meanest of existence, in the darkest pits of dementia, with the most severe chronic illness there is still a value to life. This is why we do not perform euthanasia in Western medicine. I speak from a lot of geriatric experience- I work in a long term care ("unskilled", supposedly) facility with a locked dementia wing. The decision about who to perform surgery on is a complex one; surgery is much more dangerous and much more likely to result in compromised quality of life in the more elderly patient, therefore other techniques of management will probably be preferentially tried first. I personally think that many of our elderly are over-medicated, which causes so many associated needless problems. As far as her being cognitively "starting to go" making you think, realize that dementia follows a different rate and track for almost every person who experiences it. If she is just beginning to suffer from short term memory loss and some confusion, she's got a LONG way to go before she hits full blown dementia, and at her age will probably die before reaching that point. Also, "starting to go" may mean something totally different to her daughter than it does to the staff who work with her on a daily basis... so bear in mind that is a very subjective description. Wendy CO EMT-B

The hardest words to say in any relationship: "You're right, and I'm sorry." This means actually embracing what your partner is trying to tell you, understanding it on a level where you can validate it, and apologizing for not paying attention sooner. Basically, listen to what Dwayne said... he's a lot more practiced at this marriage thing than I am. If there's other stuff going on in the home front, make sure you attend to it and that you're not hiding behind the job (especially without realizing that you're doing it!) Also, the simple fact that you work nights may mean that you are in fact more detached than you were before you started pulling a lot of night hours. It messes with your brain (she sez as she sits here at work at 2am) and can really affect you a lot more than you realize it does. Make sure you're getting adequate sleep and nutrition, and you may want to supplement with some Vitamin D- you're not getting as much sun exposure so I'm willing to bet money your D levels are low. Also, if you weren't working 60 hours before and you are now, you can bet your sweet arse it's having an effect on you. Only you know your situation, and kudos for seeing a counselor to be proactive... and while email/FB may be easier at first, sometimes it's TOO detached, if you know what I mean. There's no substitute for face-to-face interaction IMHO. In any argument, make sure you're prefacing things with the word "I"... not accusatory "you" statements. I know it sounds dumb. But trust me on this. "I feel like you are having trouble adjusting to my schedule... how do you feel?" instead of "You're just having a hard time adjusting. You'll get over it." Another good way to have an argument: Set a timer. She gets three minutes to just talk without any interruption. Then you get three minutes. This forces you to ACTUALLY LISTEN to what your partner is saying instead of automatically formulating your response to it. One thing I know that bothers me a lot is when I'm having a discussion with the hubs and he starts talking over me (usually when we're arguing something dumb, like whether or not "National Opt Out Day" was a good idea ethically, morally... etc.) That, more than him disagreeing with me, irked me more than anything else. Good luck to you! Wendy CO EMT-B

So, Kiwi- what do you do? Treat as if cardiac d/t index of suspicion, or monitor as a potential side effect until you get to definitive care? This is why it sucks not being able to use all the tools to gather all your info... a 3 lead or 12 lead would be HIGHLY useful here... unless the side effect cardiac pain also causes EKG changes... does that happen with albuterol tx? Wendy CO EMT-B