tskstorm

On my ACR/PCR there is a box that says "presumptive diagnosis" in that box I've seen EMT's and Medics write "Rule in xyz" "Rule out abc" "see comments" "unknown etiology" "RMA" I saw an ACR yesterday while I was on an ICU rotation doing chart review which said "PE vs CVA" at first glance I was thinking this is silly, a Pulmonary embolism vs a stroke ? and based on the other info in the ACR the patient presented with Shortness of breath with wheezing and AFib the Medics treating gave 2 Albuterol treatments and paced the pt. I was quite confused on the presumptive/working diagnosis ... upon reading the comments/notes closer I realized in the comments the person used PE to mean Physical Exam, and wrote CVS to mean Cardiovascular system I finally realized the Medic meant physical exam vs cardiovascular assessment. You need a good assessment to even pick a protocol to follow.. Without a working diagnosis you can't do your job correctly. Local protocols will have a different treatment order for different etiologies that lead to the same condition, the one that comes to mind is Altered mental status patients, If you suspect overdose you give Naloxone before D50, It may not alter the medications you give and the order you give it might not have an undesirable effect however you did your job incorrectly...

he was in Gulliver's Travels Info here http://www.imdb.com/name/nm0662603/

C'mon anyone? Sam Parker the 1st!

oliver hardy the fighting kentuckian with john wayne who was in the train robbers with ann margret who was in any given sunday with al pachino who was in sea of love with john goodman who was in death sentence with kevin bacon Wow that sucked .. kevin bacon too Sam parker

Kevin bacon to lisa dean ryan

buy a drug sniffing dog!! just kidding ... have you checked out http://www.drugfree.org/ they would know more than we would

Can't take away what you don't have! You guys have those on your truck? Must be nice : lol

Boris karloff Mad Monster Party with phyllis diller phyllis diller the perfect man with heather locklear heather locklear "retrosexual:the 80's" with kevin bacon Retrosexual was a very small documentary type film, which features about 150 major stars is this cheating ? lol

I read about this months ago ... I have no idea if it happened, or what .... here's something related posted from nov [web:2f765a99e8]http://www.businessethics.ca/blog/2008/11/ethics-controversial-products-virginity.html[/web:2f765a99e8] heres another story similar .. [web:2f765a99e8]http://www.silicon.com/research/specialreports/protectingid/0,3800002220,39119397,00.htm[/web:2f765a99e8]

I'm only a student don't shoot me If unable to obtain more information which I think is unfair, I would treat nothing specifically just the generic respiratory distress. Oxygen, IV, Monitor, vitals and attempt to obtain more information while giving supportive care during my 5 minute transport time, and I would follow up in the ED and learn what I forgot to ask that would have lead me to an appropriate diagnosis. There are parts to the exam you list that can indicate, everything you listed, without being able to do a more focused exam and obtain more history I don't see a systemic way to narrow it down further.

note job number 196 on best and worst job list! [web:21ec5bf6fc]http://online.wsj.com/article/SB123119236117055127.html?mod=yhoofron[/web:21ec5bf6fc]

I had a Pediatrics lecture last night, and it was briefly mentioned that kids are more susceptible to Pneumothorax than adults. This statement, got me to thinking, what size catheter we would need to use to decompress a child's chest? I would imagine different gauges, and lengths for different age/size kids but I have no reference point. Has anyone done a pediatric decompression in the field ? what did you use? Anyone have a good reference point/chart or is it a standard size? Thanks!

I found myself on a call where a taxi cab hit a gentlemen on a moped and the moped went out of control and ran into a cafe which had people dining outside. Most patients had small injuries, the main patients I focused on/saw was the driver of the moped, 40 y/o male full CNS trauma, no feeling from neck down. 35 y/o female with crush syndrome, was pinned between the moped and a fixture inside the cafe and a 40 y/o female with penetrating trauma to the back. We had 3 BLS ambulances on scene, while I was there, 2 FDNY FF trucks, and we were lucky enough to have an ER Attending eating at the cafe that day. I noticed, The EMT's on scene, did something similar to you, they all just focused in on what they were doing. I felt like a fish out of water not quite sure what to do, so I took it upon myself to direct and over see the FF's who were helping immobilize the patients, and prepare them for transport. We luckily had enough personnel on scene, we did not have to triage much, and the Physician on scene gave us a through report on arrival. I'm not sure whether or not I would have been better served focusing on any one patient like everyone else seemed to be or if it was better I did what I did. I think I had a fairly good big picture the entire time, I was on scene, but as the First arriving ambulance, as soon as the Moped driver was fully immobilized and ready for transport we took him to the nearest lvl 1 trauma center, which was a whole 5 blocks away .... I know crazy, lvl 1 trauma center 5 blocks away?

When I'm off the job I speak in slang and ebonics all the time, ask people from the city who speak to me regularly, I curse every other word if not more. To speak with slang or ebonics is normal to me, to speak prim and proper is not, but if I don't act professional when need be I wouldn't have a job. Who said anything about being less intelligent, intelligence and attitude and presentation are completely separate things. It would be my belief that the people where I work expect someone who knows their job, and knows how to relate to them. How can you pretend to know if my use of ebonics and slang is a charade? This entire post is based on assumption that I'm not real with my patients, I am who I am. I choose how to speak to different classes people, as I would choose to speak to my girlfriend's/fiance's/wife's parents differently than the I would speak to my buddies at a bar. Even if to communicate the same point you would approach it differently. To assume they are African American's is racist in itself. Dressing in uniform is dressing in uniform, we are given options and people choose to use the options presented. To say I look like a slob in itself is unfair, as you have never seen me in either uniform. For that matter, people who do wear the cleaner cut set, can still be slobs if there uniform inst clean and neat. Being a slob is based on more than the set of clothes you choose to wear. Soon as Christmas break is over I certainly can show it to a professor, however I do not think a professor in sociology or anthropology would have the full picture. Perhaps a sociology or anthropology professor with a background in psychology would be a better fit, as most of how I communicate with the patient is about getting them to open up to me in the 20 minutes I am with them.

How you dress, act and speak directly affect a patients confidence in you, to upper class persons you address it one way, to drug dealers in Harlem, or in the South Bronx you will address it another. Anyone who thinks you can effectively communicate the same point to both ends of the spectrum, in the same manner, is diluted to say the least. If you can't relate to your patient, they wont trust you, and they will choose not to tell you something that may or may not be key to your assessment and treatment. For the record, I'm nearly done with my B.S. and have taken my share of sociology courses, although I will agree I haven't taken a communications class.

You focus on the pants and missed the entire point of the post.

Well working in Harlem has taught me many things, and one of them is you must speak to your "clientele." One of the best ways to relate to your patient, and avoid getting hurt is to speak to them on there level. Its also essential to understand the slang they use, this will help you in many ways, especially when obtaining a HPI or PMH also drug slang is huge. Speaking in slang/ebonics will also help the patient, by reassuring them you're on the same level, and might even help them open up. I work for a company where uniforms vary, not everyone wears the same thing, everyone looks professional and has similar basic items, but things are slightly different. In Harlem, you could expect bdu's, a work shirt, and a non ems baseball cap. When I work midtown, and the clientele are upper class, you can expect slacks with no cargo pockets, a button down and hair appropriate. Here again you try and stay on the patients level, and speak and act accordingly, basically make them the center of your universe and no mater how silly or back breaking it might be. Slang serves its purpose, and has appropriate uses.

You're all wrong its.... E- Extra M- Marital S- Sex

Just a foreign concept, I'm not aware of anyone paying per call.. however, He is a volunteer why should he be keeping track of the patient number if there is no pay check ?

So shouldn't a bookkeeper be keeping this number, not the provider?

how lame do you have to be to count the number of pages, or patients anyway ... don't you have better things to do ?

I concur sir !

All in all I would have to say there are at least 15-20 Services in the 5 boroughs/area's that make up NYC area. To explain everything about how the system around here works it would be quite lengthy and wouldn't really assist this thread.

There are actually a few of them!

If your patients can distinguish Volunteer from Paid that's an issue in itself. Distinguishing, 1 patch from another is one thing, but if you are quotting patients as saying "they would rather the volunteers" the entire system is horrible. With this in mind things like standard of care come to mind how do they play a role in your system? Not that I want to reduce myself to a pissing match, I just have to say for every time you can site a volunteer going above and beyond, I can name someone from one of my locally paid services doing the same or better. EMS needs to get away from pissing on one another, and treat the bottom line which is the patient. Supervisory positions, promotions, paid, volunteer, municipal, private, does not matter if we are all delivering the standard of care. When my family is ill or injured, I only hope for skilled providers not one service over another, not one supervisor over another. Everything else that I think is rude, crass and arrogant so I will save that for my next EDP! Just kidding Oh yea, and volunteers and volunteer agencies should be done away with case and point ... Crown Heights Riots. Google it...