Asysin2leads

Dibs. I saw it first. Its mine, you go get your own. [GVideo]http://video.google.com/videoplay?docid=972261160202705044[/GVideo]

You know, Rid, I'd like to see the rates of penetrating brain trauma from nasal intubation sometimes. I've seen the X-ray photos, but I would be willing to bed that those are the exception rather than the rule.

Man, that's gotta suck. What is Boston's problem? There is nothing worse than snootiness in EMS. Look, paramedicine is not brain surgery, despite what some of the emotionally disturbed members of this profession may try and make it out to be. How many nurses are working as ER techs waiting to get promoted, lol. Look, you have two medics, throw some syringes at them, toss 'em an EKG monitor and some narcotics and have 'em go save some lives. They'll be happier and your system will be better two. Okay, now, as for me, so long as I get my paycheck, I'll mop the floors if they want me too. Anyone who thinks working a BLS bus is somehow below them needs to get a life and seriously reevaluate themselves.

Okay, okay, okay, the adults have talked too much and now I'm really confused. Dust, I'm curious, if a person can be safely KEDed in the driver's seat, and a backboard can be stabilized running from the passenger's set across the console to under the patient, and the patient can be safely rotated onto the backboard and secured without opening the driver's side door, what in terms of physics causes the patient detriment? I'm not trying to be a wiseass or challenging you, I really am curious, is there some sort of stress this technique would cause that I'm not aware of? I can see your point about going through the roof, even if everything is tight, you still can place strain on the hips and neck if you are yanked upwards from a sitting position,I can see your point. But can you fill me in on the difference between transferring someone onto a backboard with a KED in place towards the driver's side versus the passenger's side?

I'd say that if you are really zoned out and then crash, you might not remember the specifics of your drive up until the point of the crash, but you'll definitely remember the specifics of the crash if you are not memory impaired. You may not be able to recite every song you listened to on the radio before you went off the road, but why you went off the road, whether you lost control or swerved to avoid Grandma McGurk, you'll definitely remember that. An analogy would be that if you were really engrossed in the latest best seller, you may not remember your clock chiming on the wall, but if someone comes up and punches you in the face, you'll remember who hit you. If someone can't remember the events prior to the crash, and they are not on alcohol or drugs, either they have a concussion or contusion, or they feel asleep while driving. In any event, the bottom line is that if someone is suffering memory deficits s/p an MVA, its time to go see Mr. CAT scan at Mr. Trauma Center, no matter what the intricacies of neuropsychology might be.

Dust pretty much answered the question in his own kind, sugar coated way. Don't sweat whether you are holding someone's hand or not or duty to act or any of that stuff, know the law, know how it works, know what will get you in trouble, but ultimately, the decision to help someone should be a matter of whether its the right thing to do or not, not the subtle nuances of negligence law. Now, see, I don't even know whether to say that or not, because I think I'm opening up a can of worms for every freewheeling, half cocked, freshly minted EMT in the world to go out and try and play hero, which, of course, I'm not saying, I'm saying its a just a matter or principle. See, If I'm walking home and I see someone laying on the street, unless they are obviously a homeless person sleeping one off, I'll stop and give 'em a shake and see if they're ok. I'm not doing it because I have duty to act or because I'll get sued if I don't, I do it because I think its the right thing to do. If I didn't have genuine concern for my fellow human being, I really should not be in this business in the first place, and I think that should be the guiding principle at all levels. The only scenario I could possibly think of that you could find yourself in is a sudden cardiac arrest. If you are in a hospital room and grandma McGurk codes, rather than starting CPR, go get the nurse, or even press that button that says 'Emergency' or 'Code' that most hospital rooms have in them (not the nurse call bell, we all know that never works, right Dust? :wink: ). I say this because (hopefully) if you yell for help, the time between the code and CPR being started will be negligible, and small amount of time that elapses between you starting CPR and the nurse starting CPR is really insignificant versus the risk of a BLS provider starting CPR on someone who doesn't need it while they are in the hospital. That job is for the residents. Now, on the other hand, if you are in the lobby, and Grandma McGurk who was in for a cardiac work up goes into arrest while you are standing next to her, and all you have around you is security guards giving that stare that only someone who makes $7.25 an hour before taxes can manage, well, I personally would say go for it. If you are right and they really are in cardiac arrest, rather than just say syncopizing, and bruddah, you'd better be right, no one is going to fault you for starting CPR. Then again if you crack a few ribs on Grandma McGurk when you thought she was in arrest but really she was just dehydrated and hypotensive and on a beta blocker, you and the hospital are in very much lots trouble. And if you are in the lobby at 10 p.m. and the hospital is deserted save for you, McGurk, and the janitor, and she goes into arrest, and there is an AED right there hanging on the wall... and you know how to use it, well, you probably shouldn't. No, you definitely shouldn't. You definitely, definitely, absolutely shouldn't. I probably would, but I can be a real tunnel-vision impaired, shortsighted moron sometimes, too. Start CPR and call for help. That's the only scenario I an think of you might find yourself in. Splinting, bandaging, OPA's, NPA's, Backboards, KED's, assisting with aspirin, albuterol and/or NTG, ipecac, activated charcoal, instaglucose, or emergency childbirths are right the eff out.

Ya beat me to it, ak. This woman embodied pretty much everything that is good about humanity. Guess God had an opening for another angel in heaven.

I didn't read all the posts because I didn't feel like it. The only thing I would have done differently was to use a KED because the woman did not meet the rapid extrication criteria. If you can get the KED on safely, the patient on the backboard, and the patient out safely without adding fire engines to the equation, we call that good utilization of resources. A single BLS crew could have handled this call, it sounds like.

Most codes are really PR work/grief counseling services. You show up, you do a good job, you let the family know everything was done, and by your mere presence you facilitate the healing process. On most non-salvagable codes (which is 99.9999% of them) my priorities become to minimalize the psychological impact on the loved ones, run the code as smoothly and efficiently as possible, and to minimalize financial impact on the family. I've lost track of how many codes I've run, but I do know how many I've worked where when we arrived the patient was still talking to us, though. Now, if you want a real mind bender, that'll do it everytime.

Okay, I don't know whether to laugh, be horrified, or both. http://www.newbernsunjournal.com/SiteProce...p;Section=Local Okay, no its really wrong, and awful, and a disgrace to our profession and way of life. Still, there is something vaguely amusing about it all.

Training is for the known. Education is for the unknown. -----Poster at EMS academy Couldn't have said it better myself. If you ever want to have some real fun, take a bunch of highly trained, but poorly educated people, and put them into a situation they have not been in before. Play the Benny Hill theme while doing so, sit back, and enjoy.

You know, I guess I'm kinda surprised someplaces have a problem with ALS handing off to BLS. Never thought it was such a big deal, really. If the patient is stable, the BLS crew is comfortable, and everything is on the up and up, I think its efficient use of resources.

Okay, as a master of sarcasm and satire, I still can't figure out if this guy is joking or not. The above response to the initial post leads me to believe he is, but its really horrifying to me think maybe he still isn't.

Firefighter, good luck with your endeavours, and I'm glad you are going to school. I honestly think you do need a little therapy though, because you seem to be having some problems adjusting to civilian life. Relax. I'm sure you hold traction just fine, no one is saying you're necessarily wrong. I think you might have some issues that are far more complicated to work out then a busted leg, but its okay. You know, I could be my normal wiseass self and put in my $.02 about the "horrifying death scream", but the truth of the matter is I just don't have the heart too, because I really feel bad for you firefighter, just by reading your posts I can see you have some real issues. EMS will always be there, but if you continue to use it as a way to hide from your demons, its just going to get worse. Face your problems, deal with them, then approach EMS, you'll find you will be a much happier individual.

Ve haff vays auf making you talk. Klaus, get zee... pupil torch <DUHNNT DUHNNT DUHNNN!!!>

Firefighter: One word: Decaf. Relax, calm down, take a deep breath, just because someone went to college doesn't mean they're better than you, you don't have to fly into a rage. Its ok. We're all friends. You have what is known as an inferiority complex, but with a little therapy, and perhaps some medication, you'll be able to move on. While I was in the hospital cafeteria the other day, two orthopaedic surgeons were in line so I used the opportunity to ask them their opinion on reducing an open fracture in the field, given the risk of infection. They're consensus was far from surprising. Basically, they felt that if the person is maintaing perfusion to the distal extremities, and you have a relatively short transport time to the hospital, then the protrusions should be covered in sterile dressings moistened with normal saline and the limp splinted in the position found. However, if there is significant compromise of blood flow to the extremity and/or you are in an area where transport time will be prolonged, reduction should be attempted after grossly decontaminating the protuding bone with a normal saline rinse. Given that these two were surgeons at the specialty trauma center, I'm going to take their word on the subject.

I'm starting to feel like I'm reviewing the film from last night's game with these, but here we go again. A while ago we had a really great discussion based on a call I did about differentiating ventricular tachycardia from an SVT with a variancy, looking at related signs and symptoms. We discussed whether someone could be in ventricular tachycardia and still maintain a pulse, be AOX3, and look generally okay, or if we could take someone who showed something that looked like V-tach on the monitor but presented normally as having an SVT with a variancy. Basically, I've had two calls where someone had an EKG that looked exactly like V-tach, but later turned out to be funky SVT's. Okay, now, hit the lights, and lets go to the tape. Halloween night, 1535hrs, recieved call for difficulty breathing, job text states "male at location difficulty breathing...possible stroke". Arrived to find 76 year old man AOx3 sitting comfortably with firefighters on oxygen on chair on sidewalk, sts he had a few drinks with friends today and then passed out while in a store. States he feels fine now and doesn't want a hassle, asks if he could just get on the bus and go home. Convinced by crew and friends to be assesssed. As stated above, pt. sts he suffered brief period of syncope lasting approximately 30 seconds while in a store, negative chest pain, negative SOB, negative dizziness, negative nausea/vomiting, negative seizure activity reported. PMH: Stent placement surgery. Meds:Plavix. Allergies: NKA. VS: BP 80/P, HR 150, RR 20, GCS 15, SPO2 98% PE: PERRL, skin cool, dry, negative cyanosis, negative JVD, trachea midline, negative accessory muscle use, equal chest expansion, lungs clear bilaterally, abdomen soft, non-tender, positive fecal incontinence, PMS present x 4 in extremities, negative edema. EKG: Wide complex tachycardia, looks very much like v-tach. Okay, so now I'm ready for this one. The guy who presents with mild complaints but shows something that looks like v-tach on the monitor, right? Not only that, we now have amiodarone, which will work on either an SVT or a ventricular rhythm, so I am ready to treat the crap out of this rhythm. I have my partner start setting up the amiodarone drip while I get IV access, as I expound on my knowledge of SVT's with variancies. Patient then states "Hey, its getting really bright in here," slumps to the side, becomes unresponsive, loses pulse and becomes apneic, with no change in the rhythm. I Immediately apply defib pads and defibrillate at 360 joules (recent protocol change, no more stacked shocks in pulseless v-tach/v-fib, hit them right off with 360, and yeah, one of these days when the patient suddenly arrests on me I'll have the presence of mind to try the precordial thump, but until then they'll get defibbed and like it), patient immediately converts to RSR, regains consciousness and seems remarkably non-chalant for being dead a few seconds ago. This is pretty much how the conversation went: Me: Ummmmm.... how you feeling? Pt: Fine, why? Me: Uh, does your chest hurt at all? Pt: No, should it? Me: (under breath) Well, I did just put 360 joules through you... Are you sure you feel okay? Pt: Yes, I feel great... Though I feel awful about making in my pants before, though, how embarrassing, you know. Why, what's up? Me: Well...uh... your heart just kinda stopped there for a minute, I had to shock you to restart it... you don't remember any of that? Pt: No... You're kidding me, right? Me: No, no I'm not. Pt: So are you sure I gotta go to the hospital? Me: Yeah, I'm sure. Administered Amiodarone drip 150mg in 100 cc's D5W, transported without incident. Patient presented with no complaints in ER, remained AOX3 at all times, transferred to MICU for observation. I did learn first hand an important answer to the question I had posed in my previous post, and that is yes, a patient can walk, talk, sing and dance and still be in v-tach and about to arrest. So the Halloween trick was that after my experiences with SVT with variancies, I was given someone who really was in V-tach, and ha ha ha, someone somewhere is having a laugh about this, because I swear to God this crap only happens to me. But then, the Halloween treat was that he introduced me to his waiting family as "the guy who saved my life", and yeah, that still feels really good now and then.

Rave parties??? Oh, my imagination runs wild.

Dwayne, you're right, for a trauma and an MI (unless we can treat it with streptokinase in the field), scene time is a crucial factor. However, most calls are not major traumas or MI's. Most calls are runny noses, broken ankles, and panic attacks. If a doctor spends more time in the field on one of those calls, the patient is still being treated. Besides, give the docs a little more credit, I know I'm going to open the door for "stupid wet behind the ears doctors who are all edumacated and citified" anecdotes, but the truth of the matter is a doctor will probably know better than anybody that getting someone to the OR quickly is crucial on a trauma.

NO MAN JUMP KITS ARE AWESOME ITS JUST LIKE YOU JUMP ON OUT OF THE AMBULANCE, DO A ROLL, AND BOOOKOW!!! LIFES SAVED ALL OVER THE PLACE! WOOOOOO!!!! ---- JUMP MASTER MEDIC

All right, gonna have to disagree with you on this one. First of all, any time you are reducing circulation to a really important and large limb, such as the leg, that bleed had better be something like a lawn sprinkler or something, because bruddah, if the patient loses his leg because of your BP cuff, he ain't gonna be happy. There's a difference between a true tourniquet, which completely shuts off blood flow to an affected area, and basically using a modifed pressure point technique, which reduces the arterial pressure of an injured vessel and helps in controlling bleeding. Yes, tourniquests are getting a lot of attention in Iraq and Afghanistan, but not because they are a safe and easy way to control bleeding, but because they are not often used outside of the battlefield, and there's lots of them over there. The reason tourniquets are used is because on the battlefield, we have to take into consideration such things as bullets and mortars and IED's. A simple bleed that can be controlled with a little time and pressure in civilian EMS may warrant a quick tourniquet to prevent the corpsman or combat lifesaver from getting his head blown off in the process of applying pressure. Tourniquets do not usually lead to acidosis or hyperkalemia, in fact, that's not usually the reason we don't like to use them. The reason we don't like to use them is because when properly applied they shut off circulation to the affected limp, and cause tissue necrosis and nerve damage, which isn't good for a limb. In my experience, the body does a much better job stopping serious bleeds then I ever assumed. Unless the transection is particularly jagged, the normal low pressure of the veins and the smooth muscle spasms of the arteries do a pretty good job in slowing or even stopping blood flow in most severe injuries. I guess I'd say if the BP cuff trick works, use it and be merry, but if the person's bleeding is not life threatening (I wouldn't classify the kid with a hand injury as a life threatening injury), be cautious and be sure to make sure its okey dokey with your medical director and that the person's hand doesn't turn white and go numb while you're doing it.

Okay, everyone repeat after me... The reason scene time is increased is because the doctor is treating the patient. The goal of EMS is getting treatment to the patient, not getting the patient to the hospital as quickly as possible. Scene time is a measure of the delay to the hospital, and to definative treatment. If the doctor is doing definative treatment in the field, then scene time isn't a factor. Man I feel like I'm beating my head against a wall!

Its funny you know, lowering EMS standards, well, that's okay, but an MD who actually went to college and medical school working on people in the field? Perish the thought! Oh lord it would be anarchy. Nah, let's stick with our 50 volunteers on an ambulance with 2 certifications and 300 patches amongst them model of medicine. Actually, I don't think MD's are really necessary on day to day 911 operations, it just cracks me up some of the responses. Volunteer First Responders, good, MD's, keep them away. Where are our priorities? On major MCI's our physician medical director does respond and is part of the incident command system, as well as being able to give class orders, or temporary adjuncts to protocols. In addition, he has also been dispatched to scenes that warranted it, such as a protracted pin job that needed definative care initiated in the field. We are lucky in that our medical director was also a paramedic at one point, so he really knows his stuff. And he doesn't even get to wear a patch!

Offer driving tips from the back seat. Crews love that.

Timmy, I have a few shares left in the Brooklyn Bridge Purchase and Reinvestment Corporation, if you're interested.