Two Medical Call Reviews

[brentoli]

Also never ever let anyone tell you not to try and diagnos your findings. I'm an EMT for 17 years with The New York City Fire Dept. Bureau Of EMS and in my job I'm required to give a diagnosis on my report. If you don't try you won't learn. If your wrong so what!! When you find out the answer you'll be ready for the next time a simular incident occures and become a better tech. I'm guessing a medic gave that comment.

Friendly suggestion....

Get a few hundred posts under your belt and get estabilished around here before you end something with a snide remark like that.

Or better yet, don't do it at all.

Seriously, read around the board a little bit... You will see why that isn't the wisest thing.

[joesph]

mobey

Ya, I'll bet you feel all warm and fuzzy knowing somewhere some EMT is going to work at McDonalds since people are killing his career by doing it for free!

There is no nobility (sp?) in volley EMS.

I am amazed at the naive illusions some paid EMS "professionals" still have about volunteer services. Do they not realize that there would be paid services in all areas if the people could afford them. Sadly that is not the case so people rely on volunteers to do what is needed and have for many years in fact most if not all fire and EMS services started as volunteer. As far as that hapless soul working at McDonalds perhaps he or she has reached the top of there skill levels and peeked out. Perhaps we should remember who were there for

Edited April 15, 2009 by joesph

[chbare]

I am amazed at the naive illusions some paid EMS "professionals" still have about volunteer services. Do they not realize that there would be paid services in all areas if the people could afford them.

Way off topic; however, you are absolutely wrong. We taxpaying Americans are being hit up to bail out banks, companies, and major organizations. We are talking billions upon billions of dollars. In fact, we are starting to hit countries like China up for money as well. We are pumping money into failing companies like that money is raining down from a giant manna storm of the century.

However, people still argue that we cannot have paid EMS, they argue there is no money?

Take care,

chbare.

Edited April 15, 2009 by chbare

[akroeze]

I am amazed at the naive illusions some paid EMS "professionals" still have about volunteer services. Do they not realize that there would be paid services in all areas if the people could afford them. Sadly that is not the case so people rely on volunteers to do what is needed and have for many years in fact most if not all fire and EMS services started as volunteer. As far as that hapless soul working at McDonalds perhaps he or she has reached the top of there skill levels and peeked out. Perhaps we should remember who were there for

At the service I worked for there was a base that on did about 60 calls per year yet there were 2 paid staff provide round the clock coverage. How is that possible at such a low call volume when each of those two staff members are making $27ish/hour? Or rather, how is it possible that other places that get hundreds of calls per year insist they can't justify paid?

[oz_paramedic_chick]

I'd really like to know if she was on any psyc meds. Sometime certian psyc meds taken together for the first time can cause a reaction called " a distonic episode". The pt is usually excited, yelling and drooling when this happens for the first time and there mouths seem to be always open ( cause of drooling).

I beg to differ this NYCEMS. I have personally seen a dystonic reaction first hand and the patient is far from excited let me assure you. A quick google will even disagree with your symptoms there. A dystonic reaction may cause the mouth to hang open or may cause trismus (difficulty opening mouth) as our patient had. The trismus in her jaw actually forced her jaw of centre to the extent it almost looked like her mandible was dislocated. This also caused her difficulty speaking. Our patient was also having muscle spasms in her arms and legs and lordosis (swayback), along with torticollis (head to one side). For further reading I suggest the emedicine link off google. So unless I have gravely understood you I believe you are misunderstanding what a dystonic reaction is. If anyone else knows any different please say because I have never heard of a dystonic reaction as NYCEMS described it and would be interested to hear other people's views.

[fiznat]

Also never ever let anyone tell you not to try and diagnos your findings. I'm an EMT for 17 years with The New York City Fire Dept. Bureau Of EMS and in my job I'm required to give a diagnosis on my report. If you don't try you won't learn. If your wrong so what!! When you find out the answer you'll be ready for the next time a simular incident occures and become a better tech. I'm guessing a medic gave that comment.

The fact that you work for the fire department of NY really has no relevance here whatsoever, but if you feel that gives you some credibility then have at it.

I understand that it is important for providers to grasp at least on some level what it is they're dealing with on the ambulance, but I think it is also good practice in the presence of an illusive, idiopathic problem, to simply make sure that the basics are covered. There is nothing wrong with not knowing what exactly is wrong with your patient. In fact, any reasonably humble EMS provider should be well versed in the feeling. If you read what I said, I simply gave the advice that the poster make sure that the BLS is solid before going zebra hunting.

And oh, its a bit of a pet peeve of mine. We're not diagnosing anything in the field. We build a clinical impression and develop a treatment plan based on that impression. It is a dangerous thing to start getting into the mindset that we, with our level of education and training, understand pathology on the level that a physician might. Not that it isn't a good thing to follow up with patients and work to stay sharp. It is. ...But a little knowledge is - and will always be - a dangerous thing.

Edited April 15, 2009 by fiznat

[emsboy_2000]

NYCEMS,

Dystonia is usually defined as a state of abnormal tension or muscle tone. I, too, have never heard of dystonia manifesting so hysterically. If you could cite a source supporting what you've posted in regards to dystonia, I would appreciate it.

Edited April 15, 2009 by emsboy_2000

[NYCEMS]

I beg to differ this NYCEMS. I have personally seen a dystonic reaction first hand and the patient is far from excited let me assure you. A quick google will even disagree with your symptoms there. A dystonic reaction may cause the mouth to hang open or may cause trismus (difficulty opening mouth) as our patient had. The trismus in her jaw actually forced her jaw of centre to the extent it almost looked like her mandible was dislocated. This also caused her difficulty speaking. Our patient was also having muscle spasms in her arms and legs and lordosis (swayback), along with torticollis (head to one side). For further reading I suggest the emedicine link off google. So unless I have gravely understood you I believe you are misunderstanding what a dystonic reaction is. If anyone else knows any different please say because I have never heard of a dystonic reaction as NYCEMS described it and would be interested to hear other people's views.

You are correct, but of the 6 incidents I've personally encountered in 2 of them the pt was extremely excited due to this being the pt's 1st ever episode. True they were unable to speak but still grunting loudly, understadably in fear. The others had symptoms of there jaw appearing locked in the open position. There bodies trembling. Some even had a towel in there mouth due to all the saliva. Each one had just begun a new psyc med along with there usual. Each 911 call came in as a seizure. My point is I believe the pt we are trying to diagnos in this forum appears to me a psyc related condition.

Edited April 15, 2009 by NYCEMS

[NYCEMS]

The fact that you work for the fire department of NY really has no relevance here whatsoever, but if you feel that gives you some credibility then have at it.

I understand that it is important for providers to grasp at least on some level what it is they're dealing with on the ambulance, but I think it is also good practice in the presence of an illusive, idiopathic problem, to simply make sure that the basics are covered. There is nothing wrong with not knowing what exactly is wrong with your patient. In fact, any reasonably humble EMS provider should be well versed in the feeling. If you read what I said, I simply gave the advice that the poster make sure that the BLS is solid before going zebra hunting.

And oh, its a bit of a pet peeve of mine. We're not diagnosing anything in the field. We build a clinical impression and develop a treatment plan based on that impression. It is a dangerous thing to start getting into the mindset that we, with our level of education and training, understand pathology on the level that a physician might. Not that it isn't a good thing to follow up with patients and work to stay sharp. It is. ...But a little knowledge is - and will always be - a dangerous thing.

Diagnos, clinical impression. One's done in the hospital the other is done in the field. All the same to me. As far as my job I wasn't tring to boast. I was just stating that I've been with a busy 911 system for a long time and have encountered numerous calls. Plus people are always questioning our backround. I put mine up front. I zebra hunt when I'm not sure, it's called up triage. Then I get the answers from the Doctor so next time I'm ready.

I've noticed that lots of people like to put down EMT's. Calling us unknowledable or inexperienced. I've always believed you have to be a good EMT before you can be a good Medic. BLS BEFORE ALS. But people forget where they came from. I'm not tring to put down Medic. I know some who are great. But I hate it when I hear one put down a Tech. Also I totally disagree with you comment as far as knowledge. Book smart goes hand in hand with hands on experience. Knowledge is power. When your at a call you want that power to provide the best pt care you can. That's the guy I want treating my family. Otherwise your just an ambulance driver.

Friendly suggestion....

Get a few hundred posts under your belt and get estabilished around here before you end something with a snide remark like that.

Or better yet, don't do it at all.

Seriously, read around the board a little bit... You will see why that isn't the wisest thing.

Not to concerned about the established part not to sound arogant ( which I'm sure I'll be called) I feel I have the experience to speak my peace. But your right as far as my comment, my apologis to the Medics. I have nothing against medic's. I'd love to be one but other resposibilities prevent me from persuing it. So for now I'm happy being a EMT. I just hate comments that put EMT'S down and unfortunatly I usually hear it from medics. Hey I'm not here to make enemies. We all do the same job, helping people. I get a little defensive when I hear someone being attacked. Help them out, givem the answer and make them a better Tech.

PEACE BROTHER AND SISTER TECHS.

[rat115]

On the first run, her BP did start dropping after we got her on O2. I was watching for focal neuro problems. Didn't see them. On the second run, we were only about 2 minutes out from the ER so after getting a BP and calling in a report to the ER, there wasn't much else he could do. We were moving her from the cot to the ER bed when the airway obstructions started and an ER nurse took care of it because we had our hands full of sheet. We couldn't get a temp either time because of her rolling around the first time and screaming the second. Labs were drawn at the ER at least the first time and probablly the second to see what changes there might have been.

We were unable to get the information about medications from the husband or daughter. Her doctor was the doc on call with the ER that day, so he had the information and wouldn't share it either. (Personally, I don't like this doc.) The dementia had been getting worse and she'd had similar episodes that the PD had to be called for but this was worse than those were according to the PD on scene on the first call and her husband both. The husband and daughter noted that she has days that are really bad and days where she's almost like she was years ago mentally, but the second type are slowly getting less and less often.

This pt has had a tendency in the past to have her BGL get up that high. She's only tended to have problems with the hyperglycemic side when it hits above 250. Our normal call for her is her being hypoglycemic.

On a personal side, I've got an uncle with a form of dementia. When he was first starting out with his dementia, it was like this. I tried to find out the pt meds on this call because the form that my uncle has can actually be worsened by certain medications. He's got what's called Dementia with Lewy Bodies or Lewy Body Dementia. It's a tough one because it also has s/s of Parkinson's Disease mixed in with the dementia.

Mobey....Sorry that you don't like volly EMS. There are some areas where if it weren't for the volunters there wouldn't be any EMS. I can tell you for a fact that HERE none of our EMTs work at McD and none plan on going there to work since they have majorly messed up schedules. You have to realize that I'm 3 hrs from any metro area. The towns in the area I live in range from about 500 to 3500 in population and normally take about 5-7 minutes to drive across. Right now, we're trying to get our county commisioners to hire at least a couple of people to cover days since we're having a hard time getting coverage from 0700-1700 Monday thru Friday. Unfortunately, we're also dealing with them trying to take budgeted money from us for equipment upgrades that we seriously need to cover shortcomings elsewhere in the budget. It's something that our EMS Director has been fighting for for almost 3 years, and Colorado just passed a tax increase on auto tags that's to go to rural EMS agencies for the sole purpose of hiring full-time staff. SO.......Until we all live in the perfect world, there will still be areas where people must volunter to know that their family and neighbors are taken care of.

Edited April 15, 2009 by rat115