Eydawn

Seems to me I've seen this before.. I think what I got from it was that you can't use thrombolytics to *prevent* VTE... you can only use them to treat the acute problems caused by the clot detaching and lodging somewhere it shouldn't (like, oh... the lungs? The heart?) Thrombolytics are an intervention that's used AFTER the problem... aren't there other, more effective therapies to treat narrowing vascular systems and embolus formation? I thought it was shown that thrombolytics are a dangerous class of drugs, thus only to be used when you know you've got an acute crisis due to a thrown clot causing occlusion. I was under the impression that other drug therapies were more effective prophylactically... I can't remember the other article I read on it. It was a year or so ago. But that very issue was addressed... and the popular news media in some outlets took it as "the evil government regulated doctors aren't doing all they can to keep Gramma from getting a stroke after surgery"... I remember it pissed me off, lol. Anyone else? I'm not tracking clearly enough to explain my thought processes here... Wendy CO EMT-B

Depends on the state, Zip, for whether you're licensed or certified.... If they're swamped in the ED, and another paramedic is working as an ER tech... you can give your report to them. Your paperwork is there for perusal for when things calm down (unless your guy is dying, lol!) Not saying that RN's are lower or unequal... just saying the report doesn't *have* to be to an RN depending on situation. Wendy CO EMT-B

"Born to Run" - Springsteen "Animal I Have Become" - Three Days Grace Animal I Have Become "Believe" - Yellowcard Believe "Light Up The Sky" - Yellowcard "Calling You" - Blue October Calling You Anything with a good rhythm... that sounds appealing and happens to be a song I like motivates me to keep plugging on the gym equipment lol... Wendy CO EMT-B

Then it must just be Colorado (that we know of) that the developmentally disabled have full rights, regardless of mental capacity. That's interesting, to be honest! Since the de-instutionalization movement in the 60's-70's, it's been up to each state... I just didn't realize how different it was between states. My bad! In the State of Colorado persons who are developmentally disabled are considered to be their own legal guardians upon reaching the age of 18, unless they have a state or court appointed guardian. This means they have the full legal right to refuse medical or other care, just like any other adult. In the State of Colorado, *regardless* of the developmentally disabled person's ability to fully comprehend and explain the ramifications of treatment, if they are their own guardian, they LEGALLY can refuse. They also must sign all of their own legal documents and other materials; it is illegal for anyone else to sign for them. For example... an individual with DD with very advanced and detrimental diabetes is his own guardian. He refuses to bathe, care for his diabetes, or otherwise take care of his health.. and cannot be forced to do any of the above. Here's why I think this is in our state... I think Colorado is primarily concerned with preserving the right to independent decision and personal and legal rights of those citizens with developmental disabilities, EVEN THOUGH this may mean allowing people who COULD be forced to care for themselves or who COULD be forced to take important medication to refuse, and thereby cause harm to themselves. Believe me... it's really frustrating in the case of some of my clients where they refuse medications and become ill... but it *is* their legal right. ERDoc, thanks for pointing out the differences in other states, but rest assured that my fiancee and others like him in this field in Colorado are well versed in the laws (frustrating though they may be) because they have to deal with them on a daily basis. So, everyone, check to see what your state's rules and regs are concerning the ability to refuse care if you are developmentally delayed... just in case you try to force treatment on someone who's higher functioning or has snarky relatives and there's no clause for it in your state laws.... it's always better to know in advance where you're protected and where you aren't. You also can't just ask the parents if they are an adult's legal guardian; there are many parents of people who are developmentally disabled who are *convinced* that they are still the person's guardian, but have not gone through the mountain of paperwork to gain guardianship of their adult offspring, and thus the DD person has every right to refuse care, regardless of what the parents want. Again, this applies to the State of Colorado. Wendy CO EMT-B

Whoopsie! Got some misconceptions going on here about the legal status of adults with developmental disabilities. Here's how it works folks... REGARDLESS of deficit, the day you turn 18 you are considered your own legal guardian. Which means that if you refuse care, you refuse care, whether or not you fully understand the refusal... NOW, for those individuals lucky enough to have guardians appointed for them (either involved family members or a court appointed guardian) the guardians get to make the medical decisions. It is unfortunate but true, that there are people who really shouldn't be their own guardians due to a lack of capacity, but who nonetheless are. Which means, even though they have an IQ of 30, and cannot understand the ramifications of medical procedures, if they meet the criteria of alert and aware, they CAN LEGALLY REFUSE your treatment. End of story. Now... granted, there are a LOT of people with really low IQ's who won't meet the refusal criteria, but there are also a lot who compensate *extremely* well and will, and if you force treatment on them you will be guilty of assault. I can provide legal references for any interested! Since that's what the future hubby's job is right now (case managing adults with DD) he knows the laws regarding rights of refusal like the back of his hand... Wendy CO EMT-B

Tell me you're kidding?! *REALLY*? WOW..... wendy CO EMT-B

Ventmedic, thank you for that detailed overview! It was really a great read and very informative. Could you address pertussis to a greater extent? From what I saw in Michigan, it was a lot of overreaction, a few isolated cases, and a couple of seniors who really got screwed up time-wise at my college there. Is this typic of its spread? What comorbid factors go along with it? Wendy CO EMT-B

I like the idea of voluntary donations. I will not argue that I have benefited greatly from perusing the forums here and participating in active discussions... however, as a college student who's struggling to scrape by at the moment, I simply do not have the money to send in. That's part of the appeal of this site... as it continues to grow and my finances straighten out, I may contribute with cash, rather than my thoughts. I must say, I really don't like knowing who's donated and who hasn't. The fact that people who've donated get a million stars automatically seems to cheapen the act of participation here. There are many of us who have attempted to establish our credibility with posts of substance, who have been unable to give financially... and yet, there are some who have not posted much who have given, and thus get the status stars above their name. The money is important. I click the ads. I look around to see if there's things I can do to help the City (coaxing n00bs to relax and learn how forums work, for one, rather than stomping them to pulp). But once you make this a "pay to be a big shot" or "pay because you've benefited from something here or you're a loser" site, you lose the environment you have striven to create... Just my thoughts on the matter. Wendy CO EMT-B

If he was competent, GCS 15, etc. then he should have been offered an AMA as far as the butt-probing went. If he was not competent, or combative prior to the initiation of the butt probe, and it has been properly documented, then the hospital can prove they were acting in the best interests of a patient who was not competent enough to refuse care, and he has no case (or at least a harder time of screwing the ED). I'm sorry.. you can prove that you've developed PTSD from darn near anything (referencing SDN thread) legitimate or otherwise... but you can't sue your doctor for suddenly being afraid of alcohol wipes, for example... It all depends on the paper trail. Once we find out what the hospital actually did and documented, then we'll know how it is probably going to turn out. Wendy CO EMT-B

Go to your local army/navy surplus type store, and try on MEN's boots. It's hard to find good women's, the Galls are about the best out there... but I've worn men's for a long time and never had an issue. If you're a size 8 womens, you're a size 6 mens... about 2 sizes or 1.5 sizes below is the guideline for men's boots. Try Altama, Bates, Magnum (men's cut), Carolina. See if any fit. If you need to you can get an insole to help shape it to your foot. Good luck! Wendy CO EMT-B

Yes, because he was in the position of losing his appendage if intervention was not tendered immediately. I see where you guys are coming from... and believe me that I'm not squeamish about touching testicles (that came out differently than I intended... ? ...) rather I'm concerned with causing as little pain as humanly possible if my examination/intervention will not immediately benefit my patient. I didn't see where an exam would expedite anything.. but perhaps it may, so I stand corrected. Wendy CO EMT-B

I have to agree with the "if this guy is guilty" statement. With all we have to go on (and the fact he's being held without bond) I would lean towards yeah... probably happened. The sad fact is, people in the disabled population are vulnerable. Anyone who molests them or otherwise tries to hurt them is a piece of shit and barely deserving of being called human. I'm all for this guy being incarcerated for being a sex offender (when proven guilty) and losing his human privileges for the rest of his life (and yes, that's what happens to SO's. Right to privacy, choice of medical care, etc... they all disappear...) Wendy CO EMT-B

I was more curious as to what y'all thought of it... I thought it was better than some EMS portrayals, definitely. But I think it would have been funnier if the patient had *offered* the mask to the EMT... it just struck me a little strangely, is all! Good to see the responses. Wendy CO EMT-B

So I just saw this commercial by Jackson Hewitt about doing your taxes. Here's the setup... African American female driver, running lights and sirens... EMT patch clearly visible. White male attendant, EMT patch clearly visible, attending to a geriatric white male. They're carrying on a normal conversation... about taxes. She says how fast hers were done with Jackson Hewitt... he responds with "Mine don't get done that fast... and I really need the money..." and then he pulls the NRB off the patient and begins breathing heavily with it. You hear the pulse rate on the monitor accelerate, because poor ol Grampa isn't getting any oxygen anymore. My take on it: The no money part is hella funny. We all empathize with that! The driver looking into the back and discussing taxes when she's running lights and sirens? Come on. The attendant removing oxygen from the patient? Great! Make us look even MORE idiotic why dont'cha... Wendy CO EMT-B

Hell, or Gehenna, was prominent in the Pentateuch long before the established Christian church began modifying/translating/interpreting the texts. May I suggest reading some theologians like Martin Buber and others like him, especially their sections on the history of the Old and New Testaments including who wrote them, what's been translated, etc.? It's fascinating stuff. If I can find my old Christian Theology compilation, I'll let you know who wrote it. Great perspective on the evolution of the texts and the theology. Wendy CO EMT-B

You're right, looking and noting the color is exactly what I'd do. See above. I guess I still am having a hard time imagining what I could feel that I could describe to a doc to expedite the guy being seen... I know color is a key here... but... ? See where I'm coming from? Again, temperature difference... if he really couldn't feel a difference because he didn't have good thermoreceptors in his hands, yeah... I'd check for that... Wendy CO EMT-B

I will palpate and assess any body part that I feel necessary to examine for my patient's well being. This includes genitalia if the situation calls for it. Here's the problem I have with this particular scenario... by touching this patient's testicles, I really am not gathering any information that will help me treat him, and my physical exam will be repeated in the ER. All I would be doing is an exam that will be painful to the patient. I will *visually* inspect it and ask the patient to manipulate it because he has a much better idea of how much pain everything is causing him, but I won't subject him to pain from my assessment because it won't save time on anything or benefit him, short or long term. I'm not a doctor. I don't know enough physiology for my physical exam to be of much benefit in this particular instance. He's not bleeding out from it, nor is it obstructing his airway... so as a BLS technician, what good does it do me to palpate it? I'm thinking about my limits here. I can't reverse torsion, nor repair a hernia, nor cure an infection in the field. If I could do so, and my physical exam would allow me to differentiate between them and administer the appropriate treatment, I certainly would do so. The point is, my exam is not going to change my treatment, it's going to cause the patient more pain and distress, and the information isn't enough to begin an immediate treatment course. Wendy CO EMT-B

See! Erdoc will do it! Plus he probably knows a lot more about what things are *supposed* to be like down there and how to tell if it's a hernia or an infection or something else entirely. That whole advantage of actually having the equipment in question can't hurt either. Wendy CO EMT-B

yutz: a stupid, foolish, or ineffectual person. Per Merriam Webster Online, it's a Yiddish word. Reference: Merriam Webster, Scrabble Player's Dictionary. Just because it isn't in one dictionary doesn't mean it isn't a word. Dig deeper. Try the Oxford English Dictionary sometime... damn near any letter combination is a word according to that one! Returning to word association thread... Wendy CO EMT-B

Not in this case! If it aint' bleeding, threatening his life or in dire threat of being lost forever if I don't lay my hands upon it, it doesn't get touched! Position of comfort, transport, let the doc do the groping. Wendy CO EMT-B

Being as I'm a female medic, and I really *hate* the "Something is WRONG/painful with my junk!" calls, and because it ain't a life threat, NO, I'm not groping this fellow! Wendy CO EMT-B

I am thinking a slow growing hernia... since the fellow's job requires heavy lifting, he noticed it after work, and it's been progressively getting worse with no discoloration etc. Here's a random question... ask him if one is warmer than the other? Might help with the infection rule-out. Wendy CO EMT-B

JPINFV, those jobs are EXACTLY what I have been applying for. Guess what? CNA preferred... Thanks for the responses, folks. I appreciate it! Wendy CO EMT-B

Here's where I'm coming from. I am currently taking 16 credit hours, trying to finish out my Bachelor's in Science in Bio by December so I can go through the nursing program (BSN) I want starting next year. I'm working between 20-30 hours a week in a job that is really a CNA position... only thing is, they're so desperate for people in the Developmental Disabilities world that they hire anyone with a clean driving record and background check. I've had nigh on 80 hours of training from this... (not too far off from the 91 hours that the local CNA class is... where are y'all getting that CNA has MORE hours?), and the work is basically CNA work. Yes, to infection control, communication with the nurse (who's never physically in any of the homes), long term patient care, client rights (and rights suspensions), ambulation techniques (hell, some of our people can barely stand upright unassisted), fall prevention, behavior redirection and intervention (we can restrain- but only in the standing upright position with NO physical restraints other than my 2 pretty little hands...), suicide watch, meal prep, feeding, communicating with and attending to adults with both dementia, alzheimer's AND developmental disabilities, CPR, medication administration... most of this is done EVERY shift depending at which facility you're at. Now, at my workplace, it would be nice if they just sent us through a CNA class. But they can't invest in that because the average employee turnover is 5 months. So we get a hodgepodge of training to complete within 90 days of hire. I've got an edge in recognizing the medical stuff, because all they give these folks is a red cross 1st aid class and a bit of advice from our nurse. Now, I'm tired of the scheduling fubar that attacks me every single week (multiple times... I can't remember when I had a shift scheduled that stayed exactly the same as when I was assigned it...) and the fact that it's like pissing in the ocean... no matter how many times *I* call in a shift report and document that this client's infection STILL hasn't been treated and clean the house and do my job well, there's 6 others who come after me and do the minimum to get by. So what do I do? I apply for jobs that require a current EMT-B certification. Lo and behold, most of the available ones right now are in the hospital setting and prefer a CNA license along with it. The only problem is, I have the majority of the training necessary... I just don't have the god damn piece of paper that goes with it. And I don't have the finances, or the time, to add on 5 more credits at a community college. I'm barely making it as it is right now. And the field jobs... well, let's just say they're sparse, not really available in my area right now, and I'm trying to get my paperwork in order so I can volunteer (as a 3rd rider in a specific company's program) so I get that "6 months magical field experience" that I need to get hired as a full time field EMT because somehow, 5 years of prehospital medical experience in the Boy Scouts of America, 3 as an EMT, just doesn't translate. Yes, it's real medical care, yes, I worked with prehospital providers, yes, sometimes I helped transport... but it means nothing! You see where I am? I have a decent amount of experience in acute and ongoing care in a few different populations... and you know what? It means absolutely nothing. I feel absolutely worthless. I feel like I've pursued the educational opportunities that have become available to me... and I'm stuck in limbo in a job that I'm really beginning to have issues with. I have a certification that really means nothing, because at the time I pursued it, I was unaware of the drawbacks of being a BLS provider. I have experience that doesn't count for anything. I'm trying my damndest to get that undergraduate education that's so important, so I can go through the accelerated BSN and be a well rounded medical provider. But right now, I'm trying not to drown. And I'm trying to reconcile the fact that I've met many more bad CNA medical providers than I have EMT-B medical providers, yet somehow the CNA cert is the key to the doors that are locking me up right now. Does this make more sense as to what I was pondering? I understand they're different specialties. I just wish there were an experience based qualification for challenging the exam and getting the piece of paper. And there isn't. Wendy CO EMT-B

I'm asking why they want CNA's in the ED, or want their EMT B's to also have CNA licensure. That's the part that I don't get. Really. Wendy CO EMT-B