Mateo_1387

Rights versus safety. How many rights are we willing to give up in the name of safety? (TSA anyone?) If you want to search my bag, I'm going to flat out tell you no. You do not have the authority to search my bag unless you are holding a badge and a search warrant. Searching bags is not our place. If you are concerned about bombs, guns, knives, etc... then ask them to leave the bag. Otherwise, call law.

Are you ready for students then? I do not mean any disrespect, but maybe you are not as comfortable with calls as you should be to have students riding with you. Is this possible? Also, what about them makes you nervous? Is it that they might make mistakes? Or maybe you are worried about something coming back on you? Maybe you could elaborate on what exactly stresses you out about it? Also, communication goes well with any relationship, professional or not. This can help you and the student figure out how things might need to go on a scene. Are they the new student, who needs pushing, or the more seasoned student that needs a safety net you may provide... ? Helping your students learn sometimes means they have to figure things out, slowly. You may be able to start an IV quickly, though the student may need longer to become used to the process (or maybe even the equipment your service uses). I really do not know how to make you more comfortable with having students. You were one, maybe some introspective reflection can help you in dealings with students. Only advice I can give about being able to step back is and relax is to take the right hand, place it on your right gluteus maximus, the left hand on the other, and SIT ! LOL

Good to hear that you are enjoying school. Keep us updated and continue participating. By the way, welcome to EMTCity !

What everyone else has said.... Plus Go ahead and do the cardioversion. At this point, it seems safe to presume the patient's atrial loading is poor due to the rate, leading to venous congestion and subsequently pulmonary edema. The hope is to normalize the rate to allow for proper circulation of blood. With that problem fixed, her pressure should come up and can then use CPAP. As far as your question of something to do before cardioversion, are you in reference to vagal maneuvers? Being non-responsive I doubt she would follow commands. If you are brazen, you may decide to do a carotid sinus massage.

Not sure about how the LP 12 handles, but I believe the Zoll's we have, and the hospital too, can have pacing set up without the pads. So take the hospital machine, match the settings to your machine, then switch the pads. I'd try and make it a timely and coordinated operation. Speaking of this, anyone have the 4:1 button on their Zoll to take a look at the underlying rhythm? I tried it to see the underlying rhythm, because I couldn't believe it would show the underlying rhythm while pacing. How it works I have no clue, but it showed me a nice slow rhythm So, I just went to the ambulance to test it, for the Zoll, you can disconnect the pads and set up the pacer. Just to let y'all know...

I have wondered how I might react in such a situation. My thoughts are that I'd just walk out. I know it is a gamble that he might shoot me trying to "walk out", but the longer I stay and play with the aggressor, I fell it more likely to get shot. I'd probably just throw the bag down, say something along the line of "fine, have the damn narcotics, I don't care" and in the meantime be waking out the door like "ain't nobody got time for that !" Of course, this posting is only proving to show my ignorance of a situation of that caliber... (Hey, my first EMT City Pun !!!) Of course if that doesn't work, or I cannot escape, then I may just have to go all .... (play video) on him. (For those not familiar with Leeroy Jenkins, he yells out his name before going into battle) Anyways, it just seems logical to get out ASAP to me. At the point of being threatened, his demands are not my biggest concern. I would just try to get out. I really wouldn't feel too bad about leaving my EMT partner inside either, cuz, ya know, they are supposed to save paramedics and all.... Just sayin'...

No right or wrong answers huh? It seems things like risk vs benefit, confidence, protocol, and the like come to play in determining scene times. I am sure administrations also play a large roll in this question. I seem to view it like this. We are supposed to be the professional on scene, we are called to respond by the public for our services to be rendered. There is an expectation that our emergency services are completed. I also try and think of myself as a part of the continuum of care, in that what I do is going to be the beginning of the patient's treatment which will continues as they move through the system. With that being said, I do not agree with providing slack care based on distance from the hospital. Maybe you have heard the saying that goes along the lines of "respond to the call, do not react to it". Rushing to the hospital just seems like a reaction. Prioritizing treatments in a timely manner, stabilize the patient as best as possible for transport, and making the move towards definitive care with sound reasoning is how I think it should be done. Because you can pawn your work off to the hospital based on distance, should not be your primary reason for scene time. I tend to see in my area that EMS personnel are prioritizing scene time over patient care. I think a great deal of the problems stems from our administration and their priorities of load and go and the other part being a lack of efficiency in performing on the scene. For instance, are you the provider that waits to be told what to do on a call, even in cases where you may not be the leader of the call, or do you jump in and get things done? Even worse, are you that provider holding the clipboard? Tell me, what does that do for the patient? I do try and keep scene times in mind without compromising patient care. Practicing efficiently on a constant basis I think helps when you get that critically ill patient that needs definitive care, but also needs the primary and timely care you provide. I also see this issue as an ethical dilemma, in that we are supposed to provide a certain level of care to all patients. Arctickat brought up the legal term nonfeasance, Not performing indicated actions to certain population groups (in this case distance from the hospital) has usually been frowned upon. Anyone else see it similarly?

I like this question. To be honest, there have been no students for me in a long time ! Though, when I did have a few, I just followed what was done with me. Talked for a little while, tried to determine how they would function on calls, and then take a safety nap.... But looking back at what I think was warranted from my preceptors, I'm gonna have to change methods.... When I was in school, we were moved around to different preceptors all the time. What comes to mind as lacking in those experiences is being pushed. Being pushed to take charge mostly. It was easy being a team player, going with the flow, and hoping for good reviews. What ended up happening is graduating and being placed as the primary provider on an ambulance and expected to swim. I did not fail, but it did take time to reach a point of being comfortable in that roll. Knowledge and skill practice were not deficient in my program; behaviors and leadership abilities certainly lacked in the clinical department. Though I turned out fine, being pushed would have helped my confidence level. Being moved around to different preceptors each clinical probably contributed to the lack of being pushed. With the preceptor knowing they only have to deal with me for one day, why make such an investment of time in me, for that day? Going along with my previous statements, I do agree with rock_shoes about making carbon copies. Push me, let me figure it out, give support and you be the safety net, but let me play the leader, make the mistakes, and learn my way of dealing with situations. Certain folks are better teachers than others. Use those folks to teach, as it seems logical. Also, being exposed to fewer preceptors would have helped with developing training over shifts. Each new preceptor I never rode with always had to start from scratch in figuring me out, as did I in determining their expectations. Edited to take out the abusive language*

Sweet ! Damn fast. 12 lead? When has he taken his medicines, how many? Any drug use? What was he doing at the onset of symptoms? Surprise butt sex? Are you sure about that wife? Any similar symptoms (maybe less severity) in recent days? Recent illness? Any recent symptoms he may have though as innocuous?

I ask this with the utmost seriousness. How does the wife look? Describe her and her interaction with the hubby... Ok, maybe not the utmost seriousness, but I still ask it as a valid question. Otherwise, Vitals with temp EKG Medical history Medicines

Good luck with your situation. It should teach you something, weather it be medical or social skills. Only thing I really have to add is that I'm a firm believer in we teach others how to treat us. Keep that in mind. From your responses, you probably already have a sense of that though. My $0.02... Matty

The first question you ask is more along the lines of what I was trying to say. I never really thought about the one quality being out of place, leading to the thought of she doesn't belong. There are probably some sociological thoughts on that, though not to my knowledge. I get the impression you saw more than "she doesn't fit", my impression of your thoughts is she was meant to be something greater than what her current environment offers her. I kind of came to this conclusion about what you wrote. The thoughts and ideas you write of come from various experiences, biological processes, cultural behaviors, situations, and the like... Though, it seems this young girl caught your eye to make her stand out from the rest of the children, thus making her really seem like she doesn't belong in that environment. Though, at the same time, the other children probably do not belong either... its just the other children are not in focus of what you were looking at. Something else brother, it seems there is not a simple answer to the question. Maybe knee jerk thoughts/judgements of a person by themselves are superficial and shallow, but the origin of said thoughts/judgements would seem to arise from deep and complex processes... Not sure if this goes along with this discussion, but I recently posted on a friends facebook status about how offensive art still needs to be appreciated. Anyways, I wrote this in response to their post ".... Funny thing is, compared with the opposite, I think potentiation occurs causing the good and the bad to continue distancing from the other on a positive/negative spectrum. Say for example two mini vans are in a major vehicle collision, one van all obviously are safe, healthy, and the other van full of death and injury. Both separately look good or bad, but together, the lucky family looks really lucky, and the unlucky family looks like they have it even worse… Think it could be similar to that thought?

Wow ! That is bad... We actually had a poster from the Greensboro area, I believe he was the medical director for an adjacent county. NC, and the Greensboro area as described in that article, I do not believe is accurate. We have a lot of good things happening in NC regarding EMS. We have Wake County, so that trumps all.... right? The article though, was quite funny. I have to agree with Bieber though, I'd rather work on us, the rest I think will follow.

Is this in any way an indication that we arbitrarily judge others? Is a pigs pussy pork? I think so. I believe I can understand where you are coming from in your questions. I have asked the same types of questions. Why does this poor person affect me more than the others I meet? Why do I feel more compassion towards certain types of people? So far, the conclusion I have reached thus far, is that all people judge. Your religion may command no judgement. Hell, many are taught to be judgmental. Others may not even realize they are doing it. Take for example judging another person's appearance and instinctively linking that to sensing of possible danger. I'd be willing to bet that having children makes a parent's judgement of others exaggerated. Culture, experience, marketing, and biology, as you have already identified, makes sense as far as influencing judgement. I'm not so sure the alien mind probing influenced your thoughts, but, it could have happened. Man, do you really think that you thought she deserved more than the other children surrounding her? Or could it have been a knee jerk though based solely on someone that caught your eye. Its hard to imagine you think the other children deserve their situation, but maybe in comparison to this child, which in ways stood out, brought you to think of their situation, more so than you normally would?

How does the back appear? Discoloration noted? Pain to the flanks/retro-peritoneal area? With the severe tenderness, internal hemorrhage seems to be a real possibility. The bradycardia seems to be the most obvious problem, contributing to the hypotension. Has there been any other signs or symptoms that have occurred in the past few days?

Ahhh, the self reflection burnout question... Dwayne, I have to disagree with you and saying she is plainly 'cut out' for the work due to time served. (I make it sound like a jail sentence). You might not be cut out for it. I think you will truly know that in your heart though. Obviously you have the capacity to fill the position, perform the actions, and the like. Just to prove my point, how many would like to work at the pound gassing little puppies and kittehs... I'm just sayin'... A friend of mine, who shall go unnamed.....*coughs* Dwayne *coughs*.... asked me one day "what the hell are you doing scrapping people off sidewalks and not partying your life away chasing women?" I keep asking myself that same question all the time. The point of the quote is that I do not think it is abnormal to self reflect and ask the question. If anything, I think it will help you keep perspective and reaffirm to yourself why you do what you do. There are so many high and low points, happy and sad moments, adrenaline rushes and come downs on the job that provide us with many hours of instability. For many, I think that crosses over to home/personal life that it appears to be a permanent reality of how we live. This leads me to answer your last question... EMS is for me when my personal and home life has stability. When things go haywire on the personal side, the daily instability of EMS just doesn't mesh well, in fact they seem to potentiate each other. I find that it varies, when home life is not going well, work life seems to follow suit. This is my day to day answer to your question. The long term answer to the last question for me is a bit complicated. Right now, EMS is for me, but it is not at the same time. I have this wild dream to be a rich kid (at least enough to support myself) and travel full time. Of course being in EMS and full time travel are not complimentary. Though, if I did not have the desire to do some other things in life, I could say that I could do EMS for years and years. I like to think what grounds me is to have a stable personal life, and sufficient time off. During the time off, I do not surround myself with EMS, with EMTCity being an exception. The other part of knowing that "EMS is for me" is more of a gut feeling. I can talk about certain aspects I like and that I don't like. There is a part of the explanation though that is not quite tangible. You just know. When a person is in a bad situation, I believe they sense it or know it before things really get bad. Do you get that sense MedicGirl? Another question, how much non EMS/work related time do take out for yourself?

Central Spinal Cord Injury? I'm not very familiar with reading x-rays either. I'm going to guess at a hyperextension injury.

In regards to your first statement about transected spinal cord or objects lodged on the cord, and then placing that patient on a backbaord, it is ludicrous !!! You are seriously going to advocate that Kiwi's and their supposed evidence based practice do not place any patient on a backboard, but rather use a scoop stretcher and cervical collar, yet on this thread say patients should be placed on a backboard? Did the Kiwi's just change this policy in the past 5 days? It makes no sense to waste time placing a patient on a backboard with the evidence that is out there about its effectiveness in reducing neurological injury. The patient with such a devastating injury does not need the backboard, as the damage is already done. While you waste time placing the patient on that backboard, I'm going to go ahead and get them to a trauma center, so they can take care of all the internal hemorrhaging or other injuries that are more important than that backboard. Where were these "American" EMT's? Sounds like some sloppy Central American medicine. And to quote you from this thread

I hope you do not get caught for plagiarism or anything, that would be a real bummer. http://www.ems1.com/search/articles/1058465-what-are-the-requirements-to-be-a-paramedic/ In the first paragraph starting with the second sentence, it looks quite familiar.... Matty

I am a proponent for euthanasia, that is for consenting and of sound mind adults. The truth is that no law or government really has the power to stop someone from ending their life. There are multiple ways to do it. A physician does not have to be the one to perform the procedure. There is an exception to the rule, those that do not have the physical ability and means to complete such an act. Why not let a physician perform the act, in a humane manner, to ease suffering? What is this very discrete ethical difference? Is there really one? This is one of my favorite essays I read while taking an Ethics class. It is called Active and Passive Euthanasia. It is written by James Rachels. http://www2.sunysuffolk.edu/pecorip/scccweb/etexts/deathanddying_text/Active%20and%20Passive%20Euthanasia.pdf

Usually... "Hi, I'm Matt, this is Bill, Whats your name?" They give me their name, most of the time Then "How are you feeling today?" And go from there. I also try and shake their hand, its just the southern thing to do. Plus it gives me that permission to touch.

For most calls I go on, the jump bag, the Oxygen, and monitor are brought in. If the patient is visible from the ambulance, such as sitting on the porch with their bags packed, I usually don't take everything right to them. Same goes for wrecks, I figure out whats going on with the scene before dragging a bunch of equipment, that is, until they figure out backboards need to go to the landfill... I actually prefer to have the equipment taken into the home. There is nothing worse to me than having to send people to get a vital piece of equipment, while I stare at the patient, waiting on said equipment. I personally think it looks bad, and I think it looks unprofessional to not be prepared. Also, I get this pit in my stomach having to wait, almost like what I would suspect the family/friends feel when they have to wait on the ambulance. Bieber asked if anyone has been burned by not bringing equipment in, and for me, the answer is yes. Fortunately nothing became of it. On the other hand, I've had patient's with dispatch complaint of weakness, where I walk in the door, and wasn't expecting to be walking out with things like pacing going on. I have been certainly happy on those calls that I brought in the equipment. Another reason I bring the equipment in is it sets a standard. I work with people that have a less is best mentality. When you bring a clipboard into a call for a cardiac arrest, which happened in my area, its pretty sorry. I think the crew did not know it was a cardiac arrest, but still, how great did it look not being prepared? That being said, bringing the equipment in, and using it proficiently, takes practice. For instance, it makes better sense for me to quickly place a patient on the stretcher, and then take a 12 lead, rather than do it where they sit, have to move them while connected to the monitor, or disconnect then reconnect the monitor. Using the equipment and figuring out how to combat the pitfalls of the equipment makes my bad calls run smoother. Another aspect I'd like to discuss, is I ride the high horse on this subject and like the standard of carrying the cot, main bag, and Oxygen. At the same time, I hate absolutes, and am enjoying reading what other are posting. On top of it, I wonder how much damage I do to my body lugging this stuff around. There are a few people I talk to who say their knees just can't handle that kind of stress all the time. It makes me wonder, is the high road the right road? Are they just lying to be lazy (which wouldn't surprise me), or am I on my way to joining them...? I know it gets old lugging around equipment, but I feel it is a part of my job. Maybe we can do a senseless study and find out that bringing in the equipment doesn't improve outcomes...

How about reassessment after the treatment. What are the lung sounds now, capnography, 12 lead EKG, JVD still present, work of breathing, skin? Deciding to treat a patient like this is tough with the dual history. I'm curious why everyone jumped on the COPD bandwagon? What signs or symptoms made you choose one over the other? To answer my own question, I was on the pulmonary edema track because I expected a COPD exacerbation to have a lower blood pressure, especially if there is air being retained. Also, with the time the incident occurred at night, the hypertension, it makes me lean towards pulmonary edema, with COPD being a given underlying issue. Also, the run of V-tach makes me think of his heart having issues with pumping problems leading to the pulmonary edema. Matty EDITED to add content.

I am not quite convinced this is just COPD. I know there is a reference for pneumonia, but Pulmonary Edema is what is on my mind when I read this scenario. So, I am curious, is this a true call Bieber? If so, we you able to do capnography (I ask because I see an EKG, yet no capnography though you indicate it as being shark fin like). Did you actually use percussion? This is basically going to be a bunch of rambling. But... A patient presents with a medical history of both COPD and Congestive Heart Failure. It was mentioned that he does not have peripheral edema, which its absence is not an indicator that the problem is not pulmonary edema, as there are many causes. Since the patient presents with nocturnal dyspnea, his blood pressure is high, JVD present, I just get the feeling that that there is a pulmonary edema component. Now, I know it is not much evidence for pulmonary edema, yet I get the feel that it is. Actually, I really think that it could be a combination of both problems. Though, I do lean towards the pulmonary edema. Of course, I am basing a lot of this off the idea that you did not use percussion and capnography, though I would expect a loss of plateau for a COPD patient, especially with advanced disease. So, I'll jump on a limb and go down the pulmonary edema route. At a minimum, I'd use Nitroglycerin and CPAP. I enjoy the scenario, even though I am going off into left field from the rest of y'all. Matty *EDIT* I just realized after this quick rambling of a post that I am now one of the Elites. Thanks to the person that thought I was worthy of it, I'm honored.

I'm pretty sure, that there is a good possibility, without much doubt, that he has ascites... But as don as I saw him, he reminded me of pictures we've all probably seen of the child with kwashiorkor type malnutrition. Marked high caloric intake, less of the proteins and such. On examination at autopsy, probably has esophageal varicies, hepatomegaly and cirrhosis, and ascaris lumbricoides (had to look that one up) which goes along with kwashiorkor. Intestinal scarring would probably be present. There is also probably going to be cardiomegaly too, coronary blockages... Truth be told, I had to look up the name of the malnutrition characteristic with distended abdomen. Ok, I guess while I'm at it, I thought Dwayne was posting that one picture from the Orlando EMTCity gathering... Just sayin'...