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Your vacation was provided as a bonus from your old employer. Your new employer probably doesn't care about the vacation needs of rookie employees. Especially if this a competitive position, demanding they adjust their hiring schedule to suit your needs is really bad form. I mean, I guess it never hurts to ask... but... if I was the hiring manager and I took the time to offer you a position for a highly coveted spot, and you responded by asking about vacations, I'd go down to the next name on the list.

I was going to make a comment about asymptomatic hypertension and medical stability, but ERDoc will just tell me how wrong I am. I defer to him. I just brings 'em. (I don't think asymptomatic hypertension makes you too unstable to discharge from the ER). *hides*.

Its not ethical to file charges on someone that you would not have otherwise filed to achieve some medical goal. If a patient is acting inappropriately, there is a whole continuum of actions that can be taken in between not doing anything like your cops did on scene and later filing criminal charges. There is also a whole process to go through to involuntarily hospitalize a patient who presents suicidal ideation with an action plan to accomplish his goals, which as previously was mentioned, is at the State and I think Federal level because of Medicaid. What the local sheriff thinks about the whole thing isn't relevant, despite his feelings to the contrary. If they felt that strongly about the patient they should have gone through that process. A patient who is released from the hospital and then goes commit suicide is a powder keg of liability for the hospital, the cops, and your service. Make sure your report states very explicitly his suicidal ideation and what was witnessed on scene. Then flip a coin whether to start a Civil War with local law enforcement and the hospital by documenting the fact they asked you to file charges rather than go through the proper route. It sounds like your locals may need a bit of a wake up call about how to do their jobs.

Orthopaedics, paediatrics, grey, theatre, centre...

ERDoc, so I have a better understanding of the situation, how much does Medicaid reimburse for ICU stays? I mean, I've seen ICU bills run up to $100,000 a day. How much of that does Medicaid actually pay for John Q. Crackhead who refused to take his high blood pressure medication and then had a stroke, necessitating the ICU stay? I'm not trying to bait or anything like that. This topic just reminded me I wanted to find out what Medicaid reimbursement rates were for the ICU.

So Doc, if I have it straight, ERs will still be under obligation to afford treatment to those aforementioned maladies but the State will no longer be under any obligation to pay for those treatments? There hasn't been any changes to the EMTALA laws when I was asleep, right? If that's the case, then if any good comes out of it will be to produce an incentive for healthcare providers to try and keep asthma, CHF, and heart dysrhythmias managed before they become and emergency.

You know, at my last job, we were happy if the crew used the garbage cans for garbage rather than the dashboard. I can't think of any specific reason OSHA or anyone else would care if you put non-biohazardous waste in with the biohazardous waste. I know the people who have to shell out $$$ per unit of biohazardous waste disposed would have a problem with you stuffing the red bags with things that can go to the landfill rather than in the incinerator or onto the New Jersey shoreline. Food related items in the garbage in the back I do not believe would constitute evidence of eating in the back and therefore an OSHA violation. I can think of a lot of ways food related items would end up in the garbage in the back. So, to reiterate, I don't think this is as much an OSHA issue as it is a cost issue. If whoever pays the bills on your biohazardous waste disposal is okay with getting charged for throwing out your coffee cups, then I don't think the feds would have a problem with it either. If you're still not sure what I'm talking about, try putting your candy bar wrapper into the sharps container the next time an ER administrator is within line of sight. Just make sure you're in a trauma center first.

You should have just said "Yes well, I'm pretty sure you haven't worked on many critical patients either, CADET."

Icterus. Yellowing of the sclera consistent with jaundice.

Unfortunately, you'll find that fire departments insight into patient care is generally limited to putting out patients that are on fire. Try a hospital.

Wow. That's some crap right there. We used to have similar nights but we always had units to back each other up. Best of luck to you. Oh, I love that reporter Charlie. He's awesome.

Oh, and thanks for all the well wishes. I'm progressing along pretty quickly.

That being said, it wasn't you who had to play with the hand you were dealt. It was your patients who had to play. That's why being a patient was such an informative experience. I'm sure you're proud of your soothing voice and shredded GI blanket, but your patients probably were not as impressed. Happiness: I don't think the use of any analgesia currently on the market can bring pain down to a zero. The other thing I learned about in the hospital is a nerve block. Its what they did on me prior to surgery. That made any pain a 0. Of course I couldn't move my arm for a good 12 hours or so. I liked Entonox not so much for its analgesic effects but for its dissociative effects. For me it kinda more dulled the pain, which was definitely still there. Morphine, fentanyl, dilaudid, they're fun and they do work to some extent, and the euphoric side effects are a nice distraction, but still for pain control in an acute injury they can be lacking. Which brings us to multi-trauma victims. Poor, poor, conscious multi-trauma victims. Pouring water in someone's face to elicit information is in some circles considered unethical. But strapping someone with several broken bones down to a hard plastic board and taking them over rough terrain is considered proper medical procedure. For these poor souls, I would suggest conscious sedation. Even if they're AMS. Even if they're hypotensive. There's no contraindication against giving a hypotensive patient benzodiazepines, only cautions. I think we are so focused on rapid transport with trauma patients that somewhere along the line we forgot that when you're in that state, no transport is rapid enough. Until we invent the Star Trek teleporter that time between we pick them up, deliver them to definitive care, and definitive care does its thing, is usually an unacceptably long time for a patient to be in agonizing pain.

That's my new acronym for BLS. Now before everyone gets up in arms, let me recite the paramedic's pledge. "I do solemnly swear that BLS comes before ALS because EMTs save paramedics, airway, breathing, circulation and that children are not little adults, so help me, my medical director." That being said, having suffered and currently recovering from a shattered distal humerus, I have gotten a new view on what is considered BLS care, and unfortunately, its not a really pretty picture. I cannot any more accept that manipulating orthopaedic injuries with BLS techniques alone is acceptable modern medical practice. I had a very bad break. The lower half of my upper arm was in several pieces and the radial nerve was being crushed between the bone ends. I was very lucky, though. I had an excellent prehospital care team that was able to supply some amount of pain relief and did some of the best prehospital orthopaedic care I've ever seen. It was still some of the worse pain I've ever been in, and I came very close to losing significant function in my hand. Luckily I'm making a full recovery. A lot of people who dial 911 are not anywhere near as fortunate as I am. We think of the sprains and strains as the "minor" calls that maybe some of us roll our eyes at while hoping we get a "real" call, but I think its high time we approach prehospital pain relief and orthopaedics with the same attention we give STEMI's or multi-trauma victims. While I was sitting in the cast clinic, I saw a sign saying something to the effect that good casting is an art that combines psychology, engineering, medicine, and artistic talent. I think that's very true. Why don't we start moving away from the first aid kit we have left over from World War II and towards modern orthopaedics? BLS transport should become a thing of the past, IMHO, and if the best an area can do is EMT-I, then let's find a pain medicine that even they can't screw up. We shouldn't be proud of our current standards for injuries. We need to focus less on the big ones we can't do anything for and more on the little ones that we can make a tremendous difference in.

I think I've just been warped by my experiences with pushy, know-it-all students.

I would temper "taking charge" with the knowledge that you are just starting out and have no experience. I wouldn't trust someone who has never worked a code before to run a code. Do be aggressive. Don't be a shrinking violet. But I would suggest not trying to "take charge" unless you know what you're doing. One of my pet peeves is people who try to take charge who have no business taking charge. Which constitutes a great number of people I have met.

I think you're a bit confused. BLS stands for Basic Life Support. While hard to write a definition for BLS, generally speaking it involves patient assessment, first-aid, CPR, BVM, and use of basic adjunct devices. Non-invasive stuff. The "ABC's" on the other hand, stand "Airway, Breathing, and Circulation". They are part of a patient assessment. I do a patient assessment on all my patients. I would put myself in for a CAT scan if I started an IV and started giving pain medication to a person who had a compromise off the ABC's. I mean, something would be wrong with my ability to properly interact with reality if that happened. Besides making sure the person has and airway, checking if they are breathing, and making sure they have a pulse, I also do a through primary and secondary assessment including medications and allergies. I need to know that stuff before using a medication. If I find that the person has a simple extremity injury, I'll start an IV and give pain medication before splinting or realignment. Splinting and/or realignment is a BLS maneuver. But I did ALS first. OMG!!! WTF? You say ALS vs. BLS, I say proper medicine vs. half-assed barbarianism.

I swear on my balls flamingemt is just another guise of crochity/IHLPP. His/her/it's blatantly ignorant and inflammatory statements are similar to all the others. Troll or not, I have pocket lint that is more intelligent.

Five bucks says that if florists made stock options flamingemt's economic theories would be markedly adjusted. I know artists. Real artists. People not only with talent, but who work incredibly hard and persevere to perfect their craft. They are so good that they are able to support themselves. They are the 0.01% of the population who can pull that off. The other 99.9% adopting "the life" and all its accoutrements and smoking weed or doing LSD while living off student loans and writing essays about the whether the brightness of a modern art piece represents simple brightness or the artist's yearning to achieve in a phallocentric nihilist world, they're just waiting their money, my money, and their parent's money. If you haven't sold a piece in years, its because you're not really that good an artist and need to find another job.

Flamingemt, as always, your ignorance is astounding. You are one of those people I would classify as being "So ignorant, they don't even know how ignorant they are." I'm guessing a high school diploma or a GED wasn't a requirement for certification in your parts?

Maybe you should finish your paramedic coursework before commenting on the delineation between ALS and BLS and appropriate interventions. I'll tell you a dirty secret, don't let it get out. Sometimes I did an ALS maneuver before a BLS one. Like, say, starting an IV so I could give the patient pain medication BEFORE I went playing with their fractured extremity. Oh God! Horrors! The shame of it all. One day I will be in charge. And when I am, I shall stomp this ALS and BLS nonsense from the face of the earth and replace it with a modern approach to patient assessment and care. I will replace basic first aid techniques with a modern understanding of orthopaedics. I shall find those who say "BLS BEFORE ALS", and they shall feel my wrath.

If you were a good enough Florist, Designer, Writer, Actor, or Musician, how come you need to have government assistance to pay your bills? Or are you only friends with the lousy ones?

You know the song never says anything about schools or the shooter being young... just for the record. Apparently the gay rights movement is the new thought police. You know, back in the 50's, because of comic codes, Mad Magazine had to go from a comic book to a gazette format to get away with some of their humor. Particularly, in comics, it was specifically forbidden to show police, judges, teachers, anyone in a position of authority in a bad light. Well, in California, the new law going into effect will be that schools cannot teach any material that might show gays or certain religions in a poor light. Full circle. They are so far left that they have swung around to the right. Apparently in the State of California curriculum 9/11 never happened (or maybe the attackers were just really pissed off Shriners) and Gianni Versace is still alive (Andrew Cunanan broke in and poured some Chardonnay. They had a good time). I will fight, with every last fiber of my soul any law or statute that bans the free flow of information or artistic expression. That is ridiculous.

Protocols shmotocols. If your trauma patient reports loss of consciousness, or somebody else does, take them some place capable of looking inside and preferably being able to fix their noggin. Sorry for the technical terms.

I still humbly suggest trying to do your job to the best of your abilities as your main priority. If you know in your heart that you are doing your job well, then all you have to is say so to this guy. Try the rational and professional approach. Its not popular but it does work. Especially against knuckledraggers. Take the high road. Its fun to watch them furrow their brow in attempts to comprehend the situation.