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Mateo_1387

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Everything posted by Mateo_1387

  1. So you want to mutilate you baby boy, taking away something he can never regain, because of hygiene issues? Can you not just teach him keep clean, take a bath, and clean beneath the foreskin? 80% of the men in the world can do it, why can't the other 20% get with the program? A bar of soap is much less invasive than getting a circumcision.
  2. Then you my friend will want to work here They are in 1st place for now. I can.......................NO !
  3. I am confused what you are talking about Ruff. Are you meaning his umbilical cord? When a baby is circumcised, it is cut off, not left to fall off. I was thinking about this thread and it came to my mind that the less chance of STD's in circumcised men than their counterpart. What a bogus reason to be in support of circumcision. This is how I see it...The STD is not caused by the foreskin, it is caused by having sex with an infected individual. There are more "less invasive" ways to prevent STD's, such as abstinence and condoms, those are much less invasive than circumcision. I do not know about losing sleep over this subject, but it should be important to everyone, especially men. Approximately 60% of males are circumcised in the US. That is a large number of men. Such a senseless operation....and nobody seems to see it as such....what a shame.
  4. I agree with AK, I personally think that routine circumcision is not warranted. In cases severe enough, it may be warranted, but that is not the common case. The argument of personal hygiene to me is weak. Hygiene needs to be taught to prevent problems with the foreskin, not circumcision to eliminate problems with the foreskin. We all know the argument about appearance is weak.....I feel this argument is based on what people are used to. Just from a little bit of searching, I found where there were higher incidents of appendicitis than phimosis in England. It is not practical to just perform routine appendectomies. I realize the procedure for appendix removal and circumcision are different, and one is less invasive than the other, but the "routine" deal is what I am getting at. How about another approach. The routine should be to have the pinky finger cut off on the right arm. Most people are right hand dominant, the pinky serves some function in gripping, but that is about it. It has instances of getting squashed in car doors, developing infections under the nail, hangnail, and other various trauma, such as being broken. Of curse we will not have any problems with the pinky finger because it is not there, where we would have problems with it attached to the hand. If everyone had their right pinky finger removed, I am sure it would become common place, and someone with a pinky finger would be viewed as "different." Of course, anyone who questions the practice will be cited with the fact that with the pinky finger, it can be damaged, and come with problems.... Ak brings up another good point. He says "we do not know what we do not know....right?" When the foreskin is removed, it is permanent change. The decision to remove is certainly without consent. You are taking something away from the child that they may very well desire later in life. To me it is not much different than taking off that pinky finger. To answer your first question, for a male who is circumcised, I could imagine that they would feel that they may be missing a part of them that will forever be gone. I can see them as having a sense of 'I want my body to be unchanged' only to have their penis forever changed. They will not be able to get that foreskin back. As for an uncircumcised male, some may decide that they really do not like their foreskin, for whatever reason. I am sure there are some who just have an aversion to it, and that is for whatever their personal reasons are. That person may decide to have a circumcision, and will never "miss" the foreskin. For other uncircumcised males, I am sure that they would "miss" the foreskin because they have had it since birth. It goes back to what AK said, "you do know now what you do not know" To your second question, I think that the benefits of quick healing are an inadequate argument to having the operation done. I feel in the case of circumcision, it should be left to choice. After the procedure is done, it cannot be taken back. When the child grows up and decides he does not need his foreskin anymore, then he can make the change himself. It will then never be the question of, did we make the right choice for the child, it will be, did he make the right choice for himself.
  5. I am thinking there is a problem with the heart and related vessels. Some that come to mind are Tetralogy of Fallot, Patent ductus arteriosus, patent foramen ovale, aortic coarctation, and transposed great vessels. I would also want to listen to lung sounds and heart tones. I am thinking the problem is related to the circulatory system because of the increased dyspnea of the patient as well as progressive tachycardia presented with cyanosis. There could be other problems. The baby will not be feeding so it will become weak really fast. The increased workload can make the patient have hypertrophy of the ventricles. With heart and vessels defects, they usually come along with other problems, such as trasposition of vessels often comes with problems such as ventricular septal defects and patent ductus arteriosus. If the baby is having something such as aortic coarctation, then patent ductus arteriosis is the only means of receding oxygenated blood by the body.
  6. Well....Mom is probably going to be getting hungry.....So we have a couple choices, we can eat the placenta.......or we can go to IHOP. I'm thinking IHOP....... But in all seriousness, we probably need to get some nourishment for the mother, to keep the baby nourished. So...Lets start with some food.
  7. Exactly Spenac, where I work it is not required to use medical education, but I do ! :shock: Our patient's are important. I have never said that they are not. My problem is that people are getting worked up over a tattoo affecting a patient. Everyone here is assuming that they will get worked up, bent out of shape, and code in front of you if they happen to see your tattoo. Numerous people have tattoos, and a majority of the persons have a good appearance. They do not strike me as cut throat, thug, killer or anything else you want to make them out to be. We are talking about people who are wearing a uniform shirt, black pants, and a hat. All that is showing is the head/neck, and the arms. I am sure there are people who feel uncomfortable around tattoos, but to have someone make a turn for the worse is unheard of, IMO. (of course now that I say that, someone is sure to find something to discredit it, or just make more personal attacks :roll: ) I believe that with a professional attitude, being a compassionate provider, and having medical competence, we can put our patient's at ease and help them to feel better. If a provider cannot calm a patient, and make them feel more comfortable with what I previously said because there is a visible tattoo, then the patient has other problems, such as they may have Your company policy is something they have set up. I agree, if it is their policy, you can try and fight it, but the end solution may be that you are not a fit for that company. That is the company prerogative, I was under the assumption that this was just a general discussion, in general about tattoos, and being an EMS provider.
  8. Exactly what do you mean? I do not know why you think I can not handle this profession, it really is not that difficult to do.
  9. Letmesleep......I do not know of any research. There is no evidence I have seen that shows that tattoos are good or bad. From personal experience, which is all I have to rely on, I have never known any person or patient to have adverse reactions to someone who has a tattoo. I have known countless people to think tattoos are done in bad taste, but never a one to have a life altering reaction to a tattoo. Reaper.......Tattoos do not make us any less of a professional. What makes us a professional is our craft, which is to deliver medical care. Our education standards are what holds us back, not tattoos. RidRyder......We are there for the patients, as well as they are there for us, for without them, there would be no us. We need them to keep us in business. :wink:
  10. To Spenac......The "My Profession" comment is selfish. Patient's who are offended by tattoos exhibit prejudice. Our profession is to deliver medical care. Tattoos do not define our profession. To Letmesleep.......How are tattoos going to cause harm to a patient? Is there any evidence to support that tattoos are harmful to patients?
  11. My freedom of expression does not end when it affects patient outcome ! Their prejudice is their own fault, their assumptions about a person just because they have tattoo's is their own ignorance. :shock: Patients are going to be offended whether it is a black medic, or a medic covered with tattoos, or one covered with rings, or one that has nothing but a rotten tooth ! My personal rights are not trumped by my patients. What are the "rights" of a patient that trump my rights? I can see the patient having certain expectations, but not rights, when it comes to medical care. Their own damn fault. I am who I am, it is not my patient's "right" to have me changed. Again, their ignorance will be what kills them, not mine. You said it right, they make themselves worse.
  12. Thanks guys, I was not aware of any lifeguards with ALS skill sets. All the more power to them.....I guess.
  13. Eh..I was talking about the lifeguard truck. I have never heard of a paramedic certification being required in order to be a lifeguard. I know some beaches require lifeguards to be basics, but I found it odd that they called the lifeguard truck "paramedics"
  14. Just look at what the other 3 post wonder wrote two posts above your post.
  15. Are we riding on the same ambulance with the tricorder?
  16. I'll start this one off... General impression? Is the patient in great distress breathing? Resp rate, volume, quality, breath sounds? Pulse rate, quality, location? Skin color/temp, mucus membrane color?
  17. Above you.......you said it, not me ! I agree that the streets and the classroom are two different environments. Without an education, you are set up for failure. Some of the best medics I know have college degrees ! :shock: Where can I get my own basics? Obviously, there are ways of learning besides monkey see monkey do. Your basics need to go to paramedic school, not picking tidbits up from you. Change you mind already? So you think someone without even going through a basic class can handle this situation? According to you if you just pick it up from your partner, you will be the best. So do not worry about going to school, learning the medicine and science behind what you do, just go from joe off the street to paramedic in the ditch. :? I would think that the more you prepare before the situation, the better you can react to the situation. Why go into situations blind? Sure you get better with experience, but without that foundation, you are set up to fail. Textbooks cannot teach you to be experienced. But it will take you a long time to be "experienced" if all you do is go at it blindly and try to "wing it" :wink: Be educated, see the light ! Good partners do not make a good medic. It is weak to rely on your partner to be "trained." Now for my own rant... Your reply to the original poster was weak. You did not add any useful information to this discussion. Your two replies on this thread held nothing of sustenance. The Original Poster has consistently taken the time to ask very good questions. He has not posted "crap" that I have seen, and has thus far contributed to this site to make it better. He asked for our thoughts from the city, and I gave mine. I tried to show him respect to show him where my thinking leads me and possibly give him information he previously did not have, or may have just wanted re-enforced by members of the city. You wrote Puhhleeezzee......I think everyone here got that part. What we were discussing was when the tube should be put in. Why not take some time, reply to this post about when, where, and why the tube placement is important with the trauma patient. When do you think it is important to place the tube? Does it make a difference if the patient has a pulse or not? Contribute to this forum with something we can all use.
  18. Great Job. Sounds like you performed well. You intubated as a student, under a very stressful situation. :thumbright: From my education.... With trauma time is critical. In your case your patient was coded before you got on scene, chances are so great that you will not get a return of pulses. Waiting to perform intubation is probably not a problem. But your patient was dead right there (DRT). For a trauma patient with a pulse, when you arrive on scene, some things need to be done on scene. These may include intubation, chest decompression, and hemorrhage control. As I remember from trauma class, trauma patients cannot tolerate hypoxia and heat loss very well ( If I remember what Dr. Cambell wrote correctly). Irregardless of what the second "intolerable" was, I remember that hypoxia is not tolerable. It is recommended to intubate as early as possible to ensure adequate oxygenation, as well as airway protection. Even a small amount of time of hypoxia can be detrimental to a trauma patient. Sometimes things do not go "as the book says." For whatever reason, you may need to defer intubation. For example you may need to perform drug assisted intubation, your safety may be in jeopardy, or your patient may be in a bad position to be intubated, such as in a rainy field with mud everywhere, in knee deep water, or whatever you want the situation to be. Waiting to get into your environment may be key in this case. If you intubate on scene or intubate while going into the back of the ambulance, there will be a slight increase of scene time. The main idea for trauma if we are presented with an unstable patient is to perform lifesaving measures on scene, and then transport to a truma facility. Our interventions may buy a little time for the patient, but that is only to get them to what the patient needs, a trauma surgeon. I would not worry so much about everyone else stopping to watch you intubate. The should probably be finding "something" to do on scene to be helpful rather than spectating. This procedure is about the patient and their survival, not the inconvenience of the rescuer. I mean, that is what we are paid for, right?
  19. Did anyone catch who they called a paramedic?
  20. Lidocaine Jelly may be used for intubation, but I was in reference to IV Lidocaine, in order to lower ICP, and also blunt nerve transmissions. It would be interesting to find out what studies would say, if they are ever done. It always makes me wonder if what we are doing is "right" even though we really do not know. I am sure we will find out sooner or later.
  21. Nice Video Terri ! Only one thing that disappointed me.....Admin did not post his picture
  22. I know of no such information supporting the use of lidocaine. The use of lidocaine for a head injury does not have to be specific to RSI. It may be used in conjunction with nasotracheal intubation, and also oraltracheal intubation, even without a gag reflex.
  23. This problem needs to be addressed with all your paramedics. Do you think that doctors, nurses, and medics are doing it because of ignorance? Maybe they just do not know better, and need to have it addressed in their education. Good point. It is generally not good medical practice to mix and match medicine just to "try" it. Our actions should be guided by evidence, and not done in a "just to see" manner. Your desire for the medics to use one narcotic needs to be known. Also, having more than one narcotic may be applicable for patients who have allergies, or may be sensitive to certain narcotics. Generally protocols are great to have as guidelines. An already made plan allows for uniformity to patient care, as well as gives us a good guide during stressful situations. There does not need to be a "one protocol fits all patients with xyz condition" mentality. Paramedics can be protocol monkeys, but that is not what is good for the patient. The paramedic needs to have a full understanding of the patients condition, and why xyz treatment is being used. There will be cases where the "formula" will not work, and treatment can be detrimental to the patient. There has to be thinking on the medics part. Would the same criteria you use to decide which narcotic is appropriate also be used by your paramedics? Just saying...........If I have severe pain, yet I am allergic to the drug you carry, I am still not going to be very comfortable even though transport times are short. The availability of multiple medicines can mean better customer service. Just curious, why are you not a fan of too many options in an ambulance? One you stated was the potential to use multiple medications to cause a desired effect, when the effect could be reached with one medication. I am guessing there are more. Lidocaine could be left on the ambulance for cases of severe head trauma. How about Toradol with kidney stones? It would be a great medicine to have in place for kidney stone pain. There is always the chance that the Toradol does not cause the desired effect to relieve pain, where consideration of a narcotic may be applicable. You should know you paramedic's abilities, strengths and weakness. It can be a bad decision to give many options to the paramedics when they may not fully understand why one option is better than another. Trust is a big issue when deciding what options go on the truck. If it is out there, find research that may cover an issue with your service when deciding which option is best. You can always use internal statistics too !
  24. Any Idea why his heart rate is 60? How healthy did the patient appear? Did he take any medicine at all? Just thinking out loud, I figure that someone having new onset of a-fib usually does not know so until their heart rate becomes uncontrollable to the point it causes chest pain. Most people do not have problems with the a-fib, usually not more than palpitations or discomfort. Questions that raise concern for me. Why a slow heart rate? Although his ventricles are doing the "work", what is possibly causing them to reduce contractility? For someone who has hypertension, and as far as I can tell no meds, why such a low blood pressure. Some things I would consider, Right sided MI, Pulmonary Embolism, Stroke affecting the Vagus nerve causing the bradycardia. I am not convinced this man has new onset a-fib, and I am not convinced it is his problem at the moment, but rather the cause of his problem at the moment. Just a guess, but maybe a clot got away from his a-fib that is two weeks old, traveled to his brain, and is affecting the stimulation of the vagus nerve causing the man to have bradycardia, and subsequent reduced blood pressure. This would explain sudden onset, and the chest pressure 10/10 can be due to reduced coronary artery flow causing chest pressure. Of course an MI may be causing the refractory period of the AV node to lengthen, thus causing the bradycardia, and subsequent signs and symptoms. (Totally a wierd moment, but wouldn't it be interesting if the man had a heart block without the presence of p waves?) Did you have any follow up information? Did a neurological assessment reveal anything? Were there any other abnormalities with the 12 at the hospital, even though there was no presence of ST elevation? As far as treatment, I agree with oxygen, IV fluids ( because of dehydration from working outside, and Hypotension) atropine 0.5 mg I think could be indicated due to brady cardia, hypotension, significant chest pain (which technically may indicate need for pacing), as well as Firedoc's treatment of pain.
  25. Think an uninsured American like myself can get low cost healthcare there?
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