p3medic

Somemedic sends....

Then don't volunteer. EMS shouldn't be a volunteer job anyway. Not trying to start a pissing constest with the vollies, but EMS needs to become a medical profession with the education to support it.

This is the age break down for my EMS agency for Paramedics: <24: 0 24-29: 1 30-34: 3 35-39: 12 40-44: 18 45-49: 14 50-54: 17 55-59: 5 >60: 0

Perhaps, but many of your assessment findings consitant with tension ptx are consistant with other pathologies too. Hyperesonance to percussion isn't found with hemothorax, pericardial tamponade, diaphragmatic hernia, simple ptx, etc....

Money and quality EMS are two very different things. If you are looking to work in a progressive EMS system, LA isn't it. If you are looking for a good paycheck and a career ladder that gets you off the ambulance, apparently LA has something to offer you.

We've been using them for a few years now.

The fire department, and they don't do it well.

You left Newark? Where you headed?

Had this case yesterday morning. Yes, aortic dissection, bradycardia assumed to be secondary to compression of vagus nerve, she dissected from the root of her aorta to beyond the SMA....very impressive. Went from CT to the OR, don't have any follow up beyond that. She was managed with NTG for preload reduction and fentanyl for pain management in the field, nitroprusside infusion priot to CT. No beta blocker for obvious reasons.

Her blood pressure on the L arm is 168/80....with a strong pulse in that arm as well. No recent pregnancies, LMP a week ago, no change in her usual heroin/oxy usage.

IV access is achieved without difficulty. Her pulse on that arm has been weak all along, and since the BP cuff is still attached to that arm, her bp remains unchanged. She is still complaining of 10/10 chest pain...

The pain is substernal, onset was sudden while eating, non radiating. She is diaphoretic and visibly uncomfortable. Her hr is unchanged, weak radial pulse noted on R.

The pulse oximiter is reading correctly, good waveform corresponding with pts pulse. The patient can not describe the pain beyond it hurts "a lot", it was of sudden onset, 10/10 in severity. Her hr remains in the 50's, rr 18-20, spo2 100%, etco2 34mm Hg with good wave form. She is in obvious discomfort. The pain is constant, non radiating, not reproduceable. Pt does not appear short of breath.

It would be in the diff, but far down the list...if only that was her problem.

Pt doesn't remember the last time she took her meds, the heroin was from a usual source. The patient is a fairly poor historian, does report a maternal hx of "cardiac" but unsure what. Mom is still alive. She takes the hydrocodone when she can get the script filled more for recreation than an actual injury. She was sitting in a chair eating a piece of watermelon when the pain began suddenly. The pain is in the anterior chest, does not radiate. Pain is not reproduceable.

Pt is prescribed lisinopril, norvasc, trazadone, and hydrocodone, however is poorly compliant. Breath sounds are clear and equal, no jvd noted. Chest wall palpation does not reproduce or change the patients pain. She admits to only heroin use, denies cocaine, her last heroin was approx 40 minutes prior to onset of pain, intravenously. Pt has no other complaints, has been in relatively good health as of late, last meal this am, in fact was eating fruit this am when pain began. No nausea, vomiting, diarrhea or recent illness.

The scene appears safe, she is in a top floor apartment of a brick tenement in a densely settled neighborhood of multi family brick apartments, no odor of gas, gun wielding maniacs (in sight), or other obvious hazards. She is sitting on a couch, wailing in pain clutching her chest. She can't describe the pain beyond it hurts "a lot". Vitals are hr 52, rr 20, spo2 97% ra, bp 96/62 Skin is warm, slightly diaphoretic with good color. 12ld shows a sinus bradycardia in the 50's with LVH, no ectopy. Hx is for HTN, poor compliance with rx and IVDA, heroin specifically. NKDA.

Fib-flutter....In the begining of the strip it looks like flutter waves at a rate of over 300 bpm, with variable block...later the atrial activity becomes less apparent, perhaps fibrillation. A better quality tracing, 12 leads even better would be helpful.

Called to a multi-family apartment complex for a 45 yo female complaining of chest pain....

I don't see how the local police can force the issue any more than you. If the child is awake, alert with a head lac, and mom is informed of the possible consequence of not tranporting via ambulance and chooses not to, thats the end of it, period. A parent makes health care decisions for their children, so unless this patient is obviously in extremis, no one is going to force the mom to send the child with EMS. I realize in this instant the mom alleged she did not refuse transport, in which case I hope the medics have a signed refusal to refresh mom's memory, otherwise they screwed up.

Who knows? People do it all the time, its not like some rare phenomenon. A mother refusing transport of her child (assuming this is the case) has every right to do so. No cop or doctor on a radio is going to authorize removing a kid from the mother against the mothers will unless you have some really good reasons, i.e. mom is drunk, stoned, talking to the wall, house is in disaray, safety issue, etc...An awake kid with a small head lac acting appropriately is not a candidate for taking the kid against the parents will. I am making an assumption as to the small (8 suture)lac, and the fact the kid had a skull fx probably wasn't picked up until x ray at the hospital, othewise the doc at the clinic wouldn't have sent her by taxi.

So do you suggest taking a child in your ambulance against the wishes of the parent? I'd rather documemt well, get the refusal signed than to worry about a civil rights violation. We have people call 911 all the time that end up not wanting to go by ambulance, they have the right to decide. I will offer them a ride, explain why I think it may be necessary, but I don't kidnap.

Nonsense....Without all the facts, I would not pass judgement. It is entirely possible that the Mom decided to transport on her own, and signed a refusal AMA. It wouldn't be the first time a parent panicked, called 911 to only change their mind. I find it hard to believe that the crew refused to transport. Hopefully they documented well.

In the OP senario, the patient has melena and hematemesis, indicating a likely upper GI source of bleeding, with the frank blood from above, and the digested from below. The senario states and EBL of 1.5 L. I wasn't there, but with this I'm more inclined to think we are deeling with an acute, active hemmorhage.