medic53226

I did everything that everyone suggested, I saw the tractor on arrival and knew were it was and wasn't running but he was found by a person driving by and we had no ideal of how long he was there and how much he had bleed out or internally, pt is in bad condition and not looking good because of all the broken bones, and by the way there was 4 specialty doctors with the ER doctor on arrival and he had the fail segment that I had immobilized. They said on CT and Xray that his pelvis is in pieces and multiple internal injuries when we arrived I checked his abdomen again and it was rigid and like rock, and just the lightess touch he would smack you hand away, but never LOC, and at the hospital with segment immobilized the pt SPO2 92% on NRB. I thank all that wrote in and think that all you questions we make me better on my next run.

als and the next county that has the trauma 3 hospital has the same protocols and it is its support hospital that said no to the dart, they as well as us don't have RSI, PT with the fluid did increase the BP. The hospital that we are going to has on had trauma surgeon and other areas of care and ortho surgeon on hand and has a 30 bed er, they can handle this pt and the trauma 1 hospital is 1hr 30 min drive. This a actual pt I had just 2 shifts ago, and was wondering what the emt city crew would have done different and might have followed what I had did. As for the pt ER reported that he had a adb bleed due to spleen, curshed pelvis, dilocated right shoulder, fx tib/fib and had a exit wound, fx right ankel, fx ribs 7-12, they found that the pt had been ran over by the tractor, from family members that had showed up at the ER. The pt had not been on the side of the mower or thing could have been alot worst.

Pelvis unstable on pelvic girdle test, abdomen very tender to the light touch, pt alert have to have MC and is refused by MC for the dart, no jvd, trachea mid line no shift, no back pain, no chopper bad weather, and yes the do have 1 surgeon, and they have to call him in, but not on hand. 2 large bore IV's bilateral Forearms, Monitor sinus tach left rib immobilized with dressing

Scene is safe no animals, tractor has continued across the pasture and stuck on a fence, the height of the tractor is 6' from the ground, c-spine immobilized, no chopper a T Storm is moving overhead, and about to rain, pt in the field found by a passerby, unknown time frame from accident. Hot day 90's, pt very sweaty. No LOC, known prior to arrival and non after arrival. V/S BP 88/40 Resp 28 Pulse 128 Lungs clear Right/Clear upper left, diminished lower left Pupils PERL Cyanotic nail beds on hand and feet Obvious Fx to right tib/fib with deformity to right ankle, good pedal pulses in both feet no deformities noted to left leg. SPO2 90% RA Crepitis on left lower ribs Local hospital 10 mins Trauma 3 20 mins Local hospital is small and no specialty care just 3 bed er and ob with 50 some general beds What do you want to know now. I hope I answer alot of your questions, keep them coming.

50Y/O MALE PT THAT WAS MOWING A PASTURE IN THE MIDDLE OF NOWHERE IS THROWN FROM TRACTOR AS HE IS TRYING TO MOW A TREE LINE, PT IS FOUND ON HIS LEFT SIDE STATING THAT HIS LEFT LEG HURTS AND RIGHT SHOULDER HURTS PT IS AOX4 AND CAN ANSWER ALL QUESTIONS BUT, DOES HAVE A MENTAL HANDICAP, AND IS A LITTLE SLOW, NORMAL FOR THE PT, PT WHEN THROWN TO THE GROUND LANDS ON SOME BRUSH AND TREES AND A BARB WIRE FENCE. This what I will give you, now you tell me what you want to know.

It sounds in the initial call and actions that she was really seizing, but the seizure lasting 45 mins nonstop that would be a little troubling and having on before and lasting the same amount of time, and no meds that would rise some concern, but if I had any doubt I would just raised her hand above her head and drop it and if it hit in the face then, see passed and if not, and she continued to be unresponsive try a ammonia inhaler and it she can take that then either she is strong willed or you are probably dealing with seizure, but it seems that you guys/gals was right on target with your treatment.

Depending on the medical condition the pt is I generll perfer to work in the ambulance, because I can control how many people crowd around me. We don't have a SOP for this type of run, but they like for us to put the diabetic pt in the ambulance before we treat, because alot of times diabetics wake up with the sugar and then don't eat anything, so this is their way of solving a problem.

I agree with what you are saying and understand your hestation, it would have never been talked about and we would have continued with the .3 mg, if the pt hadn't be of political importance in our community, but I have never had to use the the epi 1/10000, because it is in our severe allergic reation protocol and we use the 1/1000 SQ unless they are severe or develop into severe.

Also to answer question of how long he said 1- 3 mins they should respond, but it depends on the pt, because you know as well as me that everyone reacts to a med different than the other.

I agree with what you are saying, but this is what he advised and change the protocol so that we could do this, if the pt didn't respond to the intial dose we were to give another .15 mg to the max of .5mg of the 1/1000. I haven't had a pt since that was needing to use this protocol, but I though that is was interestiing.

AZCEP, In our system our max is .5 mg of 1/1000 and we had given a pt with a allergic reation to a wasp sting and when he came out of the reation he had a terrible HA and our Medical Director said that we should start off with .15 dose and increase as needed to the max, and since the pt is mild to moderate I felt that this would be a better dose then the .3 mg that is the usual dose in most systems.

I would give as follows for a pt with the as describe conditions o2 by nrb 15 lpm 25 mg of Benadrly IV 0.15 mg of Epi per protocol 125 mg of Solumedrol and to the hospital so that if the H2 is needed, and futher assesment by the ER staff

I'm not going to get into the intubation issue, but for the glucagon issue I have given glucagon many times and have never seen a response in mins, I will give glucagon but still attempt to get a IV and if I do I will give them D50. I don't really like glucagon, but basics here aren't allowed to do sugar reading it is out of the scope of practice per the state, and I don't see why they can't but they can't just like they are nolonger allowed to use pulse OX's, because emts were basing their decison on what the pulse ox said and not on what the pt's condition was, I don't know really how I feel about Basics giving a med and diabeties being a very confusing disease, and hypoglycemia changing in a mintues notice, I feel that is best left to the persons or persons that can do something about any other problems that might arise. Thank you

One other thing as the paramedic what he would do for a pt that had his hypoxic drive knocked out ( Intubate ) amazing, the same thing he would have had to do if you would have withheld O2 because you were afraid that the medic was going to eat you. This just really pisses me off when this happens for no reason, just someone is in a bad mood taking out aggression on someone, and tries to use something they feel, wrong to belittle someone.

You did the right thing by giving the pt O2, and the next time tell the paramedic that you were in charge at the time and that you treated the pt the best you could and how you were taught and that if he would like to let someone go into unresponsive due to lack of O2 then he can do on his watch not yours, and I bet you money he would rather that pt be breathing then not, as for hypoxic drive it will take hours on hours for that to happen, you were not in the wrong for what you did you did a great job and as a paramedic, you did a great job and made that paragod job a hell of lot easier.

Patch, I read that your supervisor has past medical training in the military, but is he licensed to out side of the military, because he did in the military doesn't mean he can outside of the military. Why, I say that NRB at 6 LMP and treating the patient in the way he did make wonder what training he has, nothing against military because they are very trained personnel, but in this scenario, the super was very much in the wrong, If he doesn't have any medical license in the outside the military then your in charge of the scene not him, I had a supervisor with no medical training that worked with me through an wavier threw they state of indiana to have non medical personnel that could drive the paramedic ambulance, and at all scenes it was my job not his and their for I feel that this follows the same scenario. This should be reported to someone over his head because your the one that has the license and believe it or not its you license that they will come after. Good Luck, and your treatment was right on. 8) :wink:

Wild mushrooms can be toxic to you, their are types that you can eat and ones you can't eat, can you describe the mushrooms, if they have fins on the under side of the mushroom. Here is some info. Introduction: The Amanita spp. are a genus of mushrooms containing a few species famous for their toxicity. There are many edible amanitas, but eating the wrong one can get you into heaps of trouble, not to mention the delerium, vomiting, diarrhea, cramps, liver failure or death you may experience. Most poisonings tend to occur in people from foreign countries who pick Amanitas that look "just like" those yummy ones they ate at home or to overconfident novice mycophagists (people who wild mushrooms) who have not bothered to properly identify their mushrooms. So, if you plan to hunt the wild mushroom, make sure to arm yourself with the proper knowledge and only eat a wild mushroom in a foreign country based upon identification in that country's field guide, not a North American guide. Be sure that you use a guide and don't listen to any old wives' tales about how to tell edible mushrooms from poisonous ones. As knowledge is your best defense in avoiding Amanita poisoning when practicing wild mushroom gathering, it is wise to become familiar with all the parts of a mushroom. The Amanita are primarily identified by the presence of a universal veil completely covering immature mushrooms, a volva or cup around the base, a partial veil which may be in the form of a ring on the upper stalk, free to slightly attached white/cream colored gills, and a white spore print. Unfortunately, some of these identifying characteristics are delicate and can be removed by rain, wind or animals. This is only a major problem if you are trying to eat the edible Amanitas. It is essential that all the identifying markers be in place to differentiate between deadly Amanitas and edible ones. If after all this, you still insist on eating Amanitas, then you're on your own! Back to the INDEX The Symptoms: Amatoxins - The symptoms of amatoxin poisoning in humans are a ghoulish series of four phases, beginning with the not-too-alarming latency phase of 6-12 hours. This is followed by the gastrointestinal phase, where the human gets its first inkling that something is not quite right. The gastrointestinal phase consists of diarrhea, dehydration, vomiting and, not surprisingly, abdominal pains. The third phase begins with the patient feeling deceptively better off (another latency period) until the fourth and final phase hits. The final phase consists of the final degradation of the liver and kidney until, between the fourth and eighth day after ingestion, the patient lapses into hepatic coma combined with renal failure, ending in death. All this from a dose of 0.1 mg/kg body weight or even lower. That's not much mushroom to kill a person! cholera-like diarrhea dehydration vomiting abdominal pains drop in coagulation factors increase in liver enzymes (SGOT,SGPT,LDH) hepatic failure encephalopathy kidney damage DEATH due to combined liver and renal failure Phallotoxins & Virotoxins severe swelling of the liver cessation of bile flow Phallolysins The phallolysins are labile against acids and heat, and do not contribute to human Amanita poisoning. Ibotenic acid (and possibly its derivative, muscimol) central nervous system depression ataxia hysteria hallucinations - even worse this amino acid may drive you to drink urine. Web page: http://www.ansci.cornell.edu/plants/toxica...ta/amanita.html So their for I believe it is the mushrooms that has caused her problems.

We have a station that is supposed to be haunted, their are many people that say if you are awake around 200 you can hear someone walking down the hall. I have never heard anything but these are people that I trust and don't see any reason to lie to me. But if you think about wouldn't our ambulances be the most haunted place to work, how many people die on ambulances every year. :shock:

Ace844, We had some vol. FD guys ask us why they weren't getting called and we could only suggest what you suggested, but it seem from the look as though they had. I is bad when you go into a small town were everyone knows everyone and the pt says were is such and such on the FD, and then they show up because they either heard us or just saw us go by, that is very awkward

The service that I work for just went Paramedic on June,1 2006 and had been a Basic service for many years, and every since they went paramedic the dispatch has been having a habit of not calling the FD. I think that this is very intresting, because before that wasn't the problem it was just automatic, and now has the FD wanting to know why, now in the rural setting in my neck of the woods the vol fd is much closer 90% of the time and beat us hands down because of location. So I ask you fellow members of EMT CITY, have any of you ran into this problem, or have some ideals on how you would solve this problem keeping in mind that you don't even see the dispatchers they are based elseware. Thank you for your time.

Our Vol. Fire dept and City have their own tools and are very good at having the pts out and on the strectcher in the minimal amount of time. I think it would be something intresting to do, but they can handle it.

I got how about this the company that I once worked for sent a wavier to the State to get permission to use non medical personnel to drive the medics around because they had a shortage of EMT's. So I had to make some serious runs with non medical personnel that had never drove, touch and had anything to do with medical care, and my partner was the supervisor over all personnel that including medics and had no ideal what made medics different from emt's. Now they didn't always have this problem but they still would use this wavier to use these crews even when their was EMT's that could be the medic partner.

Indiana has a First Responder that is one step below and EMT.

I to have family that has called be late one night to ask if I would come and see if my brother-in-law had broken his big toe. It was about 12:00am and I had to be at work at 7:00am. I told her that I was a paramedic and that I was unable to preform X-rays that their were the highly educated people at the Hospital that spent most of their lives in school that could help her, and that he would be able to hop to the car. Have a nice night.

1. Why does every pt you pickup that has been drinking, has only drank 2 beers, but the truck he was driving has a trail of beer cans a city block wide. 2. Why when you ask a pt if he/she is in pain and they say yes, but are allergic to q OTC pain med but can handle anything else. 3. I found it is amazing that a pt can't feel his legs, and can regain feeling the second the doctor puts on his glove to check his sphincter muscle. WOW