Clinical Judgment and Protocols

[Just Plain Ruff]

The first clue he will have when he's wrong will be the boss saying. "Clean out your locker and get out"

The next clue will be the process server serving him with malpractice suit

The third clue he was wrong will be the judgement against him

And the 4th clue will be that now that he has been found negligent he won't be able to find an employer in his area that will touch him with a 10 foot pole.

I want to see that.

But what he won't ever realize is that he was wrong but it won't be his fault, it will be everyone elses.

I will make sure my crocodile tear supply is fully stocked.

Sent from my SPH-D700 using Tapatalk

[DwayneEMTP]

Yeah..he's a troll. I'm sorry that I ever took him seriously.

He's a volly fireman somewhere, or like someone said first semester medic...but bottom line is he's a troll.

Have a great day all...

Dwayne

Edit. You were caught lying brother, and then you posted layman information from some self help website and stated that it came from Medscape? You are beyond pitiful. But best of luck to you anyway.

Also, is it just me, or does the tone and relative stupidity of the posts feel familiar? As if we may have seen it before under a different name?

Edited April 5, 2011 by DwayneEMTP

[Happiness]

I wouldn't Dwayne take care of my dying guinea pig......and, although I am not dwaynes boss, I would definitely buy his former boss a beer!!

Cheers...

I agree dwayne isnt a vet, but he does say he knows how to make a canadian beaver feel better ..... And Dwayne Annie was going to get Admin to check some things out as she too has the same creepy crawly feelings

Edited April 5, 2011 by Happiness

[tcripp]

Very interesting forum, this one. Must say I didn't catch it at all until JohnnyBoy's post today and Ruff's reference to an earlier post.

So, if it's not too late for my 2 cents...

One of the things I like most about where I work is that what we have are guidelines, not a cookbook or step-by-step instructions. Bieber, as a new medic (I just celebrated my 1 year anniversary), I too have had to learn that it's never a single page to follow but rather how to mesh well all the options available to us to the betterment of the patient. Another thing I have learned is that as long as you can stand by your decisions and they are not grossly negligent, termination is not usually high on the list of things looking atyou. (See my posts about adenosine and "lack of RSI/intubation".)

I must admit that I did not read every post...some of it was getting to be dribble. But, what I recall most was the decision that Dwayne made to insert an I/O. So, the first place I went to review are my own Standards of Care. For I/O placement, it clearly reads "I/O therapy should be initiated in those patients who present in serious or life-threatening circumstances when IV access is unobtainable..." To me, what Dwayne did was just that...he had a patient in a serious circumstance and he clearly could not get a line. So, in my opinion, what he did is not considered gross negligence at all.

However, in my service we do not have glucagon, IM...IN...or otherwise. So for us, we have to get a line, regardless of the type/location. Now for the kicker. The ONLY drug that we cannot administer I/O just happens to be D50 without clear medical direction. So, since my medical director has made that point evidently clear, I'd be on the phone pretty quickly to get permission or I'll start driving that direction. I figure I have been given enough leeway on so many other areas, I can deal with this one when it arises.

Now, to the point of glucagon IN - while I have no scientific backing, I am aware of other services who do push it IN when an IV cannot be established. Since we have neither glucagon or IN capabilities...I haven't had the need to read up more on it.

It is a shame that when there are differences in opinion that we can't simply state, "Let's agree to disagree on this one."

*edited to add back in the spaces that magically disappeared...

Edited April 5, 2011 by tcripp

[DwayneEMTP]

...The ONLY drug that we cannot administer I/O just happens to be D50 without clear medical direction. So, since my medical director has made that point evidently clear, I'd be on the phone pretty quickly to get permission or I'll start driving that direction.

Yeah, though I had no such restrictions, I don't disagree with it...can you imagine the necrosis possibilities in an uncaught I/O extravasion (correct term with an I/O?) with dextrose? Massive! So yeah, I don't think that this is an untoward restriction at all...

...It is a shame that when there are differences in opinion that we can't simply state, "Let's agree to disagree on this one."

See, here I disagree. There is more that goes on in these threads than a bunch of mud slinging. There is the sometimes obvious, other times not so much exchange of information. But also the ability for people to practice flexing their muscles a bit online when they're not able yet to do so in the real world, debate and argument tactics to be observed and learned, the ability for people to see that being kicked in the ass, and even backed up and proved wrong sometimes is not the end of the world.

Also, sometimes it just feels good to have a knock down, drag out brawl. But, in a civil world, we would have agreed to disagree here and many would have been left with uncertainties as to what they might want to do in such a situation...Resolving those to the best of our ability before we're sitting within the situation is one of the main benefits we offer here in my opinion. It's certainly one of the main benefits that I received early on...

Dwayne

[tcripp]

See, here I disagree. There is more that goes on in these threads than a bunch of mud slinging. There is the sometimes obvious, other times not so much exchange of information. But also the ability for people to practice flexing their muscles a bit online when they're not able yet to do so in the real world, debate and argument tactics to be observed and learned, the ability for people to see that being kicked in the ass, and even backed up and proved wrong sometimes is not the end of the world.

Giggle. It must be my age. After a few pages of the 'mud slinging', I get bored. I like a good debate and can assure you that I typically walk away with learning something along the way. Heck, that is half the reason I am here. But, seriously, there has to come a point when we hug it out and move on.

...many would have been left with uncertainties as to what they might want to do in such a situation...

Uncertanties, for me, drive me to do more research or maybe even change up the question to get a different view point. Frankly, I'd like to think that is what JB was doing with his new post but it's already evident that the rest do not believe that to be an honorable intent.

Resolving those to the best of our ability before we're sitting within the situation is one of the main benefits we offer here in my opinion. It's certainly one of the main benefits that I received early on...

Can't disagree with that one at all!

[mobey]

JB needs too be sedated with Versed only, just enough that he can't cry out or make any organized movement, then drill in an IO and infuse 50ml of hypertonic fluid. Then let him wake up and tell us he felt nothing and feels fine.

Enough has been said, I only beg you JB - as you start your career in EMS and you get your first uncouncious patient, please please pay attention to the vital signs as you perform invasive maneuvers. Tachycardia and increasing BP are NOT compensatory mechanisms for unconsciousness......

I have a feeling this student already knows he is wrong, rest assured someday he will have the confidence to admit it, and change his perspective as to provide better care for his patients.

[BEorP]

If you thnk for one minute that Lidocaine is short lived in the elderly they you are dumber then I thought!!!

Johnboy, you're obviously intelligent and able to make reasonable points in the discussion. It really negatively impacts your ability to get your point across though when it seems like every other post you are just insulting other members. I am quite interested in your perspective, but it would be much easier for those of us reading through this thread to follow your line of reasoning if the personal attacks were left out of it.

[Johnboy]

Dwayne- face the facts brother- and accept it. You were fired for doing this and for good reason. Someone other then myself also thought what you did was wrong- guess what, because it was dip shit. Who in there right mind would drill a diabetic that was hypoglycemic, prior to trying glucagon?? Oh wait- you , that's right!!

Good luck, you are cool on this site , but I am quite sure you are black balled in the real world cowboy!!!

Again- I would have fired you also cowboy!!!

You are not only an idiot, buy a stubborn one at that...

[Just Plain Ruff]

Dwayne- face the facts brother- and accept it. You were fired for doing this and for good reason. Someone other then myself also thought what you did was wrong- guess what, because it was dip shit. Who in there right mind would drill a diabetic that was hypoglycemic, prior to trying glucagon?? Oh wait- you , that's right!!

Good luck, you are cool on this site , but I am quite sure you are black balled in the real world cowboy!!!

Again- I would have fired you also cowboy!!!

You are not only an idiot, buy a stubborn one at that...

Amazingly I am sure that there are people here who consider you an idiot but will not stoop to your childish level of personal attacks.