scubanurse

And what would you do differently if they had RUQ pain versus LUQ pain? All you'll be doing in the field is increasing the pain/anxiety of the patient with an exam that will be conducted in the ER as soon as the doc walks into the patients room. If they're complaining of lower abdominal pain and female, we consider it an ectopic until proven otherwise...no palpation necessary in the field for that... if it's RLQ pain then we will consider appendix until proven otherwise also, again, no palpation necessary in the field. The patient, if they are reliable can point to where it hurts and you'll have a good idea of where the pain is and what could be involved. In the field, there shouldn't be a clinical need to deep palpate the abdomen...if you suspect an abdominal aortic aneurism then you definitely shouldn't be palpating the abdomen as the pressure could cause a big problem. Abdominal pain is tough even for the doctors, you have visceral pain and somatic pain, just too many variables to allow for a reliable exam in the field. As to the OP, the idea might be that in the process of assessing the abdomen you could rock the patients lower thoracic and lumbar regions causing problems. While I doubt on the average patient that palpation could directly cause trauma to the spine, the rocking and shifting that can happen during an exam could displace a fracture. Just a thought, no way of telling what the author was getting at in your CE.

I am so sorry you guys are still having to go through this nightmare... Praying for you guys.

Age shouldn't matter. I was 16 when I joined, 19 when I became a medic, and was running my own night crew at 19. I was training and responsible for people your age and even older. Respect and responsibility should be there regardless of age. You seem very focused on being "green" and there is no reason to be. Everyone had to start sometime and kudos to you for starting now. If you consistently act like you're new, then a lot of people will treat you that way. Confidence but not over confident is the way to go. Be eager to learn, but also step up and take responsibility. Whatever department you join will likely have fundraisers. Take ownership in your department and help with the fundraisers. People will notice that and will appreciate you for it. Good luck and let us know when you start your basic training

I'm leaning towards a case of atelectasis with inadequate gas exchange r/t pain from rib fractures... I would like to see her complete labs from initial set to the most recent to see which way her H&H are trending, and her renal function tests. Physical exam I would like to know lung/heart sounds, normal BP for this patient...some LOL's naturally have very low BP's so I would need to know baseline. She's pale and diaphoretic, do we suspect that is because of pain or hypotension? Without an assessment of lung/heart sounds I would not feel comfortable making a dx... I'm curious as to why you think it could be pericarditis? Does the patient have a c/o CP or just the low sat (which isn't all that low to be honest). My best guess right now is the atelectasis though with a sat like that, BP is a little concerning until I know more about her baseline.

Welcome back

Congrats on working to get your basic and I am glad you got your headaches figured out!

Yeah....our low tonight is 15F and the low Saturday is supposed to be -6F with a high of 12F... with a good dumping of snow for the mountains

Welcome back...curious as to why it's under a new screen name but none the less welcome back

Very true over in that area. Most of the systems work great together, PG County in MD is almost notorious for it's relationship between the paid and volly side. MC where I was still had tensions, and I'm sure Fairfax is the same way. I'm curious, why have you set on Fairfax? Do you live close to a firehouse? Also are you >18? Your experience as an adult full member will be vastly different than as a junior member in any of these systems. I second Mike also on the donuts...there has been a big push to make firehouse eating healthier so bringing donuts may not be good. Best best is show up willing to do housework. The firehouse is a second home and must be kept clean and organized inorder to remain a successful working environment.

They are a good system. I was with Montgomery County in MD just across the river and we would run mutual aid with them every once and a while. Approach with lots of questions and an eagerness to help staff and learn and you'll be great.

I am so sorry friend... It is a rough time. My thoughts are with you guys.

Where are you from?

Ditto what the Capt said... ALWAYS bring the book to the first class. I've had instructors give an open book quiz the first day of class and I've had instructors tell us to return it to the bookstore.

A good friend of mine is heading there right now as a travel RN... I spent some time sailing around the BVI's as a kid...lovely islands!

I'll be thinking of y'all who are working tonight as I party it up! Anyone have a good New Year's resolution??

For the solutions, get your book out and fill out the attached grid. It really helped me to see it all laid out on one page and see the differences between the different solutions. Soluions Grid.pdf

Jay... I'm going to let you in on something here. Everyone on this forum has been burned before by someone coming in and trying to get more info about how a call should have gone, for other purposes than learning. There are people out there, not in EMS, who come to the forum and pose as an EMT to gather information for a lawsuit, article, book, etc. It happens a lot on this site and the longer you are here, the more you will see it. The way I saw the whole thread was there were inconsistencies in your wording that led some of us to think you were the EMT. If there's something that will get you shunned on this forum, it's lying. I have minimal doubt now that what you're saying is straight up and correct, but we've been in this position before, and people are cautious/skeptical. A healthy level of that is good when learning/reading things on the internet. No need to get upset or angry over this . Great post, and I'm really looking forward to some of your posts in the future!

F=C(1.8) + 32 so C= (F - 32) / 1.8 A temp difference of 1 degree F is equal to 0.556 degrees C... Math can be funny sometimes

The Knife and Gun Club is a great book... written about Denver's EMS system with a lot of fun stories and good info... http://www.amazon.com/The-Knife-Gun-Club-Emergency/dp/0871136236

Every major city I have lived in...DC included had those programs in place... And in every single one there was still gun violence. DC banned all guns...how well did that work out for the citizens in DC???

Haha I especially like the 500 below one

It is very realistic for that area. Good for you Julian! I joined my fire department when I was 16 also and it was a great experience. You probably won't be allowed to ride alone until you're 18, but that gives you two years to ride with different EMT's and paramedics, and to learn a lot. Keep your mind open and you will gain a lot of practical knowledge from the different partners. Just ask questions. You will also learn how not to behave on the ambulance

Welcome!!

weird... I have noticed...nor do I pay much attention to them?

I know what I'm doing the rest of break... reading up on suspension syndrome and acid/bases again! On another note, anyone heard of suspension syndrome causing SIADH? A nurse friend of mine mentioned it but I can't find any data to back it up...