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Posted: 8/25/2010 3:31:04 PM EDT

[#1]

Why do people who have been "feeling sick" for two weeks wait until 3:00am to decide they need to call 911 to be transported to the hospital?

Posted: 8/25/2010 3:40:47 PM EDT

[#2]

One thing I've learned from Arfcom.

Never ask a paramedic anything. They have stories that will haunt you. And they involve the morbidly obese.

Posted: 8/25/2010 3:41:33 PM EDT

[#3]

Quoted:

Quoted:
In your opinion, what kind of toll will obesity and diabetes take on this country?

The area I live in is one of the worst for DM1 and DM2 which is insulin and non insulin dependent diabetes. Obesity is also a problem as food is the main part of our culture. Race also predisposes some of the population. Diabetics are at higher risk of cardiac problems earlier in life. Just imagine a Diabetic 300 pound person who smokes and goes to the ER instead of a regular MD and is on medicaid and you get the idea.

I cant scream loud enough that those that cant afford health care should not get it . Im sorry when you are unemployed you sit at home collect food stamps,live in HUD housing, and have medicaid for you and your 5 kids you dont lose any weight. The proverbial "titty" needs to come out the mouth.

I work and have for the past 15 years. I am a 30 year old mother of 2 with several health problems. I have never smoked, drank, or done drugs. I have undifferentiated connective tissue disease (auto-immune disease) and chronic back issues from a failed back surgery. I also have SVT with rates that go to 180+ at rest. I need medications that I cannot take because I cannot afford the monthly labs that go along with the medications. When I become extremely sick I have no choice but to go to the ER. Insurance through my job is $1000 a month with high deductible and pre-existing conditions. I HAVE NO INSURANCE. I CANNOT AFFORD HEALTH INSURANCE.
I do not have Medicaid, food stamps, or any .gov assistance. So I guess I should not be able to get healthcare and I should just die and/or suffer right? Not everyone who does not have insurance is a lazy sloth. I work my ass off day in and day out just to make it. I am sick every day and have no energy. Could I qualify for disability, YES. Instead I choose to work to provide for my family despite how horrible I feel.

I don't think anyone thinks you should die. However you could either get another job or go on disability. It doesn't matter whether you are on medicaid or just not paying your ER bills, everyone else is already toting the cost of your healthcare. You could also look to friends and family, your church, or there maybe a local clinic willing to work with you. Have you priced insurance on your own?

Posted: 8/25/2010 3:44:01 PM EDT

[#4]

Quoted:
Why do people who have been "feeling sick" for two weeks wait until 3:00am to decide they need to call 911 to be transported to the hospital?

That's actually an easy one. They have been to the hospital enough to know that at 3am the ER is usually at it's slowest. And they could give a fuck less.

Posted: 8/25/2010 3:48:49 PM EDT

[#5]

I "Retired" after 15 years from EMS.
My question is do you ever feel bad for interfering with natural selection?
I could no longer feel ok with helping the incurably stupid every day all day and had to move on. And that was by far the greatest portion of my patient load.

Posted: 8/25/2010 4:01:24 PM EDT

[#6]

Quoted:

Quoted:
Rumors are that the NREMT is going to update the prehospital care curriculum soon. Have you heard anything about this and do you think there will be big changes if this occurs?

PHTLS has madea resurgence recently. Some things are being reviewed such as Inital IV being IO instead of IV , intubation may be restricted more and the LMA /King/ Combitube pushed more( I think thats bullshit) due to paramedics taking too long to intubate. We are trying a new type of CPR here that calls for continued CPR and less demand on Ventilations and we are seeing improvement already.

Kings sound retarded to me. I mean, ok, we insert the airway. Oh crap, its too deep. Alright, pull back a little...crap its displaced. Ok, now we have to re-insert and cause more trauma to the upper airway/mouth. It you're going to go with a non-visualized airway then I'm all about the combitube. That all said, intubations are great if you can do it right the first time. The Lucas and Autopulse stuff is going to make CPR easier (if they go into use w/ everyone). Then again, this is all from someone who is still wet behind the ears when it comes to EMS.

The autopulse is the cat's ass. Doing quality compressions while moving the patient from the call location to the hospital without stopping is a huge improvement.

Autopulse is a solution looking for a problem. If the patient still needs compressions by the time you get to the hospital, all we are doing is wasting epinephrine, and putting ourselves needlessly in danger. Three rounds of drugs in the house, if no improvement confirm asystole in 3 leads, call coroner. Go inservice and pick someone up that you can actually help.

IO's have a place but it shouldn't be a first line vascualar access. Drop and external jugular and move on. Can't find it? Learn where it is and stick it...you don't have to see it to place it. LMA/Combi/Kings are solutions to piss poor education and continued training. (The King is a fine airway in tactical situations) We should be spending less time in school learning about how to deal with our feelings, and learning what the strongest knot is, and learning the anatomy of the upper airway, and how to handle difficult and crash airways. And before we even consider advanced airway why don't we pull out a BVM, drop an OPA or an NPA or even better drop both, and bag them.

We should be spending more money on training, not gadgets to improve care. Despite all the extra bullshit we carry on the truck. As a percentage we are not saving any more lives than we were 30 years ago.

OP....sorry for the hijack and rant.

Posted: 8/25/2010 4:04:18 PM EDT

[#7]

Got a question to scare the recreational Viagra users. How is the more than 4 hour problem solved(Priapism)when taking Viagra?

Posted: 8/25/2010 4:25:13 PM EDT

[#8]

Quoted:

Quoted:

In your opinion, what kind of toll will obesity and diabetes take on this country?

The area I live in is one of the worst for DM1 and DM2 which is insulin and non insulin dependent diabetes. Obesity is also a problem as food is the main part of our culture. Race also predisposes some of the population. Diabetics are at higher risk of cardiac problems earlier in life. Just imagine a Diabetic 300 pound person who smokes and goes to the ER instead of a regular MD and is on medicaid and you get the idea.
I cant scream loud enough that those that cant afford health care should not get it . Im sorry when you are unemployed you sit at home collect food stamps,live in HUD housing, and have medicaid for you and your 5 kids you dont lose any weight. The proverbial "titty" needs to come out the mouth.

I work and have for the past 15 years. I am a 30 year old mother of 2 with several health problems. I have never smoked, drank, or done drugs. I have undifferentiated connective tissue disease (auto-immune disease) and chronic back issues from a failed back surgery. I also have SVT with rates that go to 180+ at rest. I need medications that I cannot take because I cannot afford the monthly labs that go along with the medications. When I become extremely sick I have no choice but to go to the ER. Insurance through my job is $1000 a month with high deductible and pre-existing conditions. I HAVE NO INSURANCE. I CANNOT AFFORD HEALTH INSURANCE.

I do not have Medicaid, food stamps, or any .gov assistance. So I guess I should not be able to get healthcare and I should just die and/or suffer right? Not everyone who does not have insurance is a lazy sloth. I work my ass off day in and day out just to make it. I am sick every day and have no energy. Could I qualify for disability, YES. Instead I choose to work to provide for my family despite how horrible I feel.

I don't think anyone thinks you should die. However you could either get another job or go on disability. It doesn't matter whether you are on medicaid or just not paying your ER bills, everyone else is already toting the cost of your healthcare. You could also look to friends and family, your church, or there maybe a local clinic willing to work with you. Have you priced insurance on your own?

Pre-existing conditions and high costs prevent me from being able to purchase insurance. Easier said than done on getting a new job. Right now I work from home typing medical records. The pay is just enough to make it. I am limited on the type of work I can do. I have no friends. I have hardly any family. I need care for the rest of my life and I doubt the churches will help with that. The clinics are not able to treat my problems and want me to see specialists. Also, sometimes I make too much money to qualify since I am based on production. Disability is out of the question, I need to work to help provide for my family. I will work until the day I die. Insurance prices are outrageous and health care costs are outrageous. Unfortunately, people that try to help themselves by working, fall between the cracks. Like I said, not all people with no insurance are lazy sloths.
I will just continue to do what I have been. Suffer until I cannot stand it anymore and become so extremely ill that I need to go to the hospital. The last time I went my heart rate was 180 and I was sent home with no treatment. The time before that I was broke out head to toe in a plague-like rash, had volume depletion, arthralgias, myalgias, high sed rate, and several other issues and they diagnosed me with lupus, which turned out to be undifferentiated connective tissue disease instead. I spent 6 days in the hospital and was in bad condition.
ETA: I did go through a program for a little over a year that gave me the treatment I needed and performed the necessary tests, but when more was needed to be done and it became that I would need life-long treatment they gave me the boot, which is understandable. Between my 3 specialists I was seeing, almost $100,000 in medical care was received in that short time-frame, which I was extremely grateful for. That did not include medication costs, I paid for all of those.

Posted: 8/25/2010 4:27:56 PM EDT

[#9]

IM sent.

Posted: 8/25/2010 4:30:51 PM EDT

[#10]

Quoted:

I have found a checkbook and a few cheetoes under a titty the size of your head.

You made me spit on my monitor with that one. lol. You didn't really find that under a titty did you?

Posted: 8/25/2010 4:37:30 PM EDT

[#11]

Do you wear your pager 24-7 even when you are off duty and cant possibly be of any service?
Ive seen this done a lot around here and wondered if its mandatory or they are just demanding attention when it goes off, they listen, then decide to not respond.

Posted: 8/25/2010 4:47:48 PM EDT

[#12]

Quoted:

Quoted:
Rumors are that the NREMT is going to update the prehospital care curriculum soon. Have you heard anything about this and do you think there will be big changes if this occurs?

PHTLS has madea resurgence recently. Some things are being reviewed such as Inital IV being IO instead of IV , intubation may be restricted more and the LMA /King/ Combitube pushed more( I think thats bullshit) due to paramedics taking too long to intubate. We are trying a new type of CPR here that calls for continued CPR and less demand on Ventilations and we are seeing improvement already.

Kings sound retarded to me. I mean, ok, we insert the airway. Oh crap, its too deep. Alright, pull back a little...crap its displaced. Ok, now we have to re-insert and cause more trauma to the upper airway/mouth. It you're going to go with a non-visualized airway then I'm all about the combitube. That all said, intubations are great if you can do it right the first time. The Lucas and Autopulse stuff is going to make CPR easier (if they go into use w/ everyone). Then again, this is all from someone who is still wet behind the ears when it comes to EMS.

The autopulse is the cat's ass. Doing quality compressions while moving the patient from the call location to the hospital without stopping is a huge improvement.

Autopulse is a solution looking for a problem. If the patient still needs compressions by the time you get to the hospital, all we are doing is wasting epinephrine, and putting ourselves needlessly in danger. Three rounds of drugs in the house, if no improvement confirm asystole in 3 leads, call coroner. Go inservice and pick someone up that you can actually help.

IO's have a place but it shouldn't be a first line vascualar access. Drop and external jugular and move on. Can't find it? Learn where it is and stick it...you don't have to see it to place it. LMA/Combi/Kings are solutions to piss poor education and continued training. (The King is a fine airway in tactical situations) We should be spending less time in school learning about how to deal with our feelings, and learning what the strongest knot is, and learning the anatomy of the upper airway, and how to handle difficult and crash airways. And before we even consider advanced airway why don't we pull out a BVM, drop an OPA or an NPA or even better drop both, and bag them.

We should be spending more money on training, not gadgets to improve care. Despite all the extra bullshit we carry on the truck. As a percentage we are not saving any more lives than we were 30 years ago.

OP....sorry for the hijack and rant.

I have to respectfully disagree with a few things here. First, we are doing significantly better than we were 30 years ago. My Cardiac Arrest ROSC (save) rate is at 60 percent of my codes for the last 3 years. My department has been over 55% for the last 3 years also. As a nation we may not be doing better, but individual systems that are doing it right have exponentially better statistics.

I wouldn't rule out IOs for first line vascular access. I get 99% of my IVs on the first shot, but when I walk in on a code-99 and have an obese pt with poor access, drilling the leg is fast and a sure thing. If you do it properly (no aspiration and a syringe pressure flush) then the drip rates are identical to a large bore IV. I still get an EJ or peripheral IV ASAP but to start with the IO works great.

Automated CPR is fantastic. I hate the autopulse, it sucks. The lucas device however is impressive. I used to have to hang dopamine on most post codes. We would get ROSC and then struggle with pressure for a while. Since I started using the lucas I almost never have to hang dopamine. We get ROSC and our first pressure comes back at 120 or 130 systolic. As soon as the code is called the engine crew has the lucas ready to put on (less than 10 seconds) and it is consistent, impressive CPR.

I do agree with you on several counts though. We do not ever transport codes in progress. We work it in place, give them several rounds of meds, then call it there if we do not get ROSC. Also, with the airway issue. This trend toward a blind insertion airway is fucking stupid. I can't count the number of times I've gone to view for intubation and found crap in the airway that I needed to clear. Or how many times I've seen those king airways cause trauma. Training is the key to airway management.

I vote for training and new gadgets. YMMV

Just my .02

Posted: 8/25/2010 5:06:19 PM EDT

[#13]

Quoted:
Do you wear your pager 24-7 even when you are off duty and cant possibly be of any service?
Ive seen this done a lot around here and wondered if its mandatory or they are just demanding attention when it goes off, they listen, then decide to not respond.

I carry mine most of the time because the services I work for tend to send out pages to notify you of anything important so having it on you is a good idea, lest you miss something. Are you talking about the alphanumeric/text pagers or the FD types with a speaker that actually talk to you?

Posted: 8/25/2010 5:26:36 PM EDT

[#14]

Let me take this one.

Quoted:
Do you wear your pager 24-7 even when you are off duty and cant possibly be of any service?
Ive seen this done a lot around here and wondered if its mandatory or they are just demanding attention when it goes off, they listen, then decide to not respond.

I live in a different county than I work. I volunteer for a combination department (career/volunteer). I carry a pager (FD style with speaker) when I'm at home and where I live. When my pager goes off for a medical call there is already a crew at the station able to respond with the first ambulance. There is (typically) no need for me to drop what I'm doing and race on down to the fire station. I simply meander my way over to the fire station and sit around handling the radios and waiting for a possible second call while the first crew is still out of service. In the event a second call is dropped before I'm at the station, I will hurry to the station and use a green light if the type of call warrants its use.

Posted: 8/25/2010 5:27:16 PM EDT

[#15]

whats your dosing amount and time interval for versed and morphine (or do you use something else)

I do anesthesia, and I spoke with a paramedic once who relayed their intervals and it was impressive how much you gave not waiting at all for peak effect

Posted: 8/25/2010 5:27:21 PM EDT

[#16]

Quoted:

Quoted:
.45 expanding. Dont ask I have seen worse. and 223 in heavier than 55 Grn

Quoted:
9mm or .45?

I know first hand that if you put a 270 under your chin but you fail to get it at the right angle, it will very effectively remove your entire face. And you will live through it.

Not something I had ever thought of before.

I would think living through this would be worse than death.

Posted: 8/25/2010 5:32:41 PM EDT

[#17]

People who ask the "What's the worst thing you've ever seen?" question don't know it, but they don't want the real answer. SIDS babies, shaken babies, dead children, nearly dead children, bloody mess traumatic arrest pedi patients, raped children, abused, starved or intentionally burnt children are the worst.

Add parental stupidity as the compounding reason for any of the above. Dream that had only someone jammed a hot soldering gun into said moron parent's genitals prior to them procreating it all never would have happened.

Posted: 8/25/2010 5:34:00 PM EDT

[#18]

Miller or Mac blade for intubation?

Posted: 8/25/2010 5:34:09 PM EDT

[#19]

No post since 5:15 must have gotten a call for a tooth ache and had a code blue come in through the main entrance.

Posted: 8/25/2010 5:36:28 PM EDT

[#20]

What (if anything) about the job stresses you out? How often does this happen?

Posted: 8/25/2010 6:39:43 PM EDT

[#21]

Quoted:
Miller or Mac blade for intubation?

Mac for me.

Posted: 8/25/2010 6:43:31 PM EDT

[#22]

Quoted:
8 years total . 2 as a FF/First Responder,3 as NREMT Basic, 3 As Paramedic
Critical Care Paramedic, CPR Instructor, PHTLS instructor
Edit- As for another field Im in a good place now. My job is good, pay is decent and I have options if I need. I cant stand being with the patients for more than 30 mins so ER nurse is out/

Rookie

Posted: 8/25/2010 6:46:16 PM EDT

[#23]

Quoted:

Quoted:
Rumors are that the NREMT is going to update the prehospital care curriculum soon. Have you heard anything about this and do you think there will be big changes if this occurs?

PHTLS has madea resurgence recently. Some things are being reviewed such as Inital IV being IO instead of IV , intubation may be restricted more and the LMA /King/ Combitube pushed more( I think thats bullshit) due to paramedics taking too long to intubate. We are trying a new type of CPR here that calls for continued CPR and less demand on Ventilations and we are seeing improvement already.

Kings sound retarded to me. I mean, ok, we insert the airway. Oh crap, its too deep. Alright, pull back a little...crap its displaced. Ok, now we have to re-insert and cause more trauma to the upper airway/mouth. It you're going to go with a non-visualized airway then I'm all about the combitube. That all said, intubations are great if you can do it right the first time. The Lucas and Autopulse stuff is going to make CPR easier (if they go into use w/ everyone). Then again, this is all from someone who is still wet behind the ears when it comes to EMS.

The autopulse is the cat's ass. Doing quality compressions while moving the patient from the call location to the hospital without stopping is a huge improvement.

Autopulse is a solution looking for a problem. If the patient still needs compressions by the time you get to the hospital, all we are doing is wasting epinephrine, and putting ourselves needlessly in danger. Three rounds of drugs in the house, if no improvement confirm asystole in 3 leads, call coroner. Go inservice and pick someone up that you can actually help.

IO's have a place but it shouldn't be a first line vascualar access. Drop and external jugular and move on. Can't find it? Learn where it is and stick it...you don't have to see it to place it. LMA/Combi/Kings are solutions to piss poor education and continued training. (The King is a fine airway in tactical situations) We should be spending less time in school learning about how to deal with our feelings, and learning what the strongest knot is, and learning the anatomy of the upper airway, and how to handle difficult and crash airways. And before we even consider advanced airway why don't we pull out a BVM, drop an OPA or an NPA or even better drop both, and bag them.

We should be spending more money on training, not gadgets to improve care. Despite all the extra bullshit we carry on the truck. As a percentage we are not saving any more lives than we were 30 years ago.

OP....sorry for the hijack and rant.

I have to respectfully disagree with a few things here. First, we are doing significantly better than we were 30 years ago. My Cardiac Arrest ROSC (save) rate is at 60 percent of my codes for the last 3 years. My department has been over 55% for the last 3 years also. As a nation we may not be doing better, but individual systems that are doing it right have exponentially better statistics.

I wouldn't rule out IOs for first line vascular access. I get 99% of my IVs on the first shot, but when I walk in on a code-99 and have an obese pt with poor access, drilling the leg is fast and a sure thing. If you do it properly (no aspiration and a syringe pressure flush) then the drip rates are identical to a large bore IV. I still get an EJ or peripheral IV ASAP but to start with the IO works great.

Automated CPR is fantastic. I hate the autopulse, it sucks. The lucas device however is impressive. I used to have to hang dopamine on most post codes. We would get ROSC and then struggle with pressure for a while. Since I started using the lucas I almost never have to hang dopamine. We get ROSC and our first pressure comes back at 120 or 130 systolic. As soon as the code is called the engine crew has the lucas ready to put on (less than 10 seconds) and it is consistent, impressive CPR.

I do agree with you on several counts though. We do not ever transport codes in progress. We work it in place, give them several rounds of meds, then call it there if we do not get ROSC. Also, with the airway issue. This trend toward a blind insertion airway is fucking stupid. I can't count the number of times I've gone to view for intubation and found crap in the airway that I needed to clear. Or how many times I've seen those king airways cause trauma. Training is the key to airway management.

I vote for training and new gadgets. YMMV

Just my .02

I have found since the change to 2minutes of CPR prior to rhythm check and immediate CPR after Defib, the need for vasopressors has decreased a good bit. Not eliminated but definately decreased. And yes the ROSC rates have increased but the number of folks discharged nuerologically intact has not changes significantly. While we may see an increase in quality hospital discharges, the evidence does not support this as of yet.

There is a place for new technology without a doubt, but not to crutch sorry medics along.

Posted: 8/25/2010 6:50:00 PM EDT

[#24]

Quoted:

Quoted:
In your opinion, what kind of toll will obesity and diabetes take on this country?

The area I live in is one of the worst for DM1 and DM2 which is insulin and non insulin dependent diabetes. Obesity is also a problem as food is the main part of our culture. Race also predisposes some of the population. Diabetics are at higher risk of cardiac problems earlier in life. Just imagine a Diabetic 300 pound person who smokes and goes to the ER instead of a regular MD and is on medicaid and you get the idea.

I cant scream loud enough that those that cant afford health care should not get it . Im sorry when you are unemployed you sit at home collect food stamps,live in HUD housing, and have medicaid for you and your 5 kids you dont lose any weight. The proverbial "titty" needs to come out the mouth.

I work and have for the past 15 years. I am a 30 year old mother of 2 with several health problems. I have never smoked, drank, or done drugs. I have undifferentiated connective tissue disease (auto-immune disease) and chronic back issues from a failed back surgery. I also have SVT with rates that go to 180+ at rest. I need medications that I cannot take because I cannot afford the monthly labs that go along with the medications. When I become extremely sick I have no choice but to go to the ER. Insurance through my job is $1000 a month with high deductible and pre-existing conditions. I HAVE NO INSURANCE. I CANNOT AFFORD HEALTH INSURANCE.
I do not have Medicaid, food stamps, or any .gov assistance. So I guess I should not be able to get healthcare and I should just die and/or suffer right? Not everyone who does not have insurance is a lazy sloth. I work my ass off day in and day out just to make it. I am sick every day and have no energy. Could I qualify for disability, YES. Instead I choose to work to provide for my family despite how horrible I feel.

I don't think anyone thinks you should die. However you could either get another job or go on disability. It doesn't matter whether you are on medicaid or just not paying your ER bills, everyone else is already toting the cost of your healthcare. You could also look to friends and family, your church, or there maybe a local clinic willing to work with you. Have you priced insurance on your own?

Pre-existing conditions and high costs prevent me from being able to purchase insurance. Easier said than done on getting a new job. Right now I work from home typing medical records. The pay is just enough to make it. I am limited on the type of work I can do. I have no friends. I have hardly any family. I need care for the rest of my life and I doubt the churches will help with that. The clinics are not able to treat my problems and want me to see specialists. Also, sometimes I make too much money to qualify since I am based on production. Disability is out of the question, I need to work to help provide for my family. I will work until the day I die. Insurance prices are outrageous and health care costs are outrageous. Unfortunately, people that try to help themselves by working, fall between the cracks. Like I said, not all people with no insurance are lazy sloths.

I will just continue to do what I have been. Suffer until I cannot stand it anymore and become so extremely ill that I need to go to the hospital. The last time I went my heart rate was 180 and I was sent home with no treatment. The time before that I was broke out head to toe in a plague-like rash, had volume depletion, arthralgias, myalgias, high sed rate, and several other issues and they diagnosed me with lupus, which turned out to be undifferentiated connective tissue disease instead. I spent 6 days in the hospital and was in bad condition.

ETA: I did go through a program for a little over a year that gave me the treatment I needed and performed the necessary tests, but when more was needed to be done and it became that I would need life-long treatment they gave me the boot, which is understandable. Between my 3 specialists I was seeing, almost $100,000 in medical care was received in that short time-frame, which I was extremely grateful for. That did not include medication costs, I paid for all of those.

It's a bad situation no doubt. Social programs exist for a reason. Not everyone that is on them is a dirtbag, and people genuinely want to help others, even us conservatives. Don't be too proud to seek help. It won't matter to your kids that their mother died a good non-welafare recieving women. Get the disability, make what money you can and watch your kids grow up and get old. Don't let your pride march you in to an early grave.

Posted: 8/25/2010 6:51:29 PM EDT

[#25]

Quoted:

Quoted:
Miller or Mac blade for intubation?

Mac for me.

Read Dr. Walls airway manual. Changed my way of thinking and intubating. Miller for me 90% of the time.

Posted: 8/25/2010 6:54:29 PM EDT

[#26]

Get off the truck and into a ED or into Industrial Medicine, your back, knees and neck will thank you. Mine did.

Posted: 8/25/2010 6:55:33 PM EDT

[#27]

Quoted:
I can only give "scenarios" but a parasite coming out of an eyeball takes the cake. And no wood on unconscious pts. I have found a checkbook and a few cheetoes under a titty the size of your head.

Meh! Thats nothing... we had a live roach run from under a titty one time! Same patient one other time... one of the guys stepped on one of her titties and she started screaming at the top of her lungs...... we thought she was crashing on us.

It was a VERY large woman... everytime we went to her.... we ended up having to remove the stretcher out of the rescue and putting her on the floor.... that's how her titty got stepped on!

Posted: 8/25/2010 6:56:21 PM EDT

[#28]

Quoted:

Quoted:
.45 expanding. Dont ask I have seen worse. and 223 in heavier than 55 Grn

Quoted:
9mm or .45?

I know first hand that if you put a 270 under your chin but you fail to get it at the right angle, it will very effectively remove your entire face. And you will live through it.

Not something I had ever thought of before.

I would think living through this would be worse than death.

It's actually a more common occurance than you would think. Rifles barrels tend to be long. People extend their neck up and over the barrel tilting their head back so that the barrel is actually pointing at their nose instead of their brain. Yes it's horrible, yes it's bloody, yes they know everything that is going on, yes eyeballs look weird when they just outside your ear. And yes, if life was difficult enough for you to attempt suicide, going around looking like the guy from that Cher movie Mask doesn't make it easier.

Posted: 8/25/2010 6:57:09 PM EDT

[#29]

Quoted:

Quoted:
Miller or Mac blade for intubation?

Mac for me.

Read Dr. Walls airway manual. Changed my way of thinking and intubating. Miller for me 90% of the time.

Is this it?

Posted: 8/25/2010 7:03:00 PM EDT

[#30]

Quoted:
Miller or Mac blade for intubation?

Millers for us!

Posted: 8/25/2010 7:03:52 PM EDT

[#31]

Do Paramedics crave donuts like LEUs or do they go for the fruit cups?

Posted: 8/25/2010 7:31:59 PM EDT

[#32]

Quoted:
Do Paramedics crave donuts like LEUs or do they go for the fruit cups?

EMTs I know go for sandwiches and energy drinks.

Posted: 8/25/2010 9:04:05 PM EDT

[#33]

Quoted:

The whole point of the Lucas and AutoPulse stuff is consistent & effective CPR. As the AHA says, it's the kind of CPR that's going to make a difference. Now that I've said that, dead is dead is dead so sometimes all the drugs in the world won't help and I get that. One of the biggest problems that had been seen w/ manual CPR was that even before the 2 min was up people were getting less effective.

For me the "best" route of vascular access jury is still out. I can see the advantages of the IO. Like one guy said, it's quick on an obese pt (who are we kidding this nation isn't getting skinnier). Then again, its going to take longer for those drugs to get to the heart where they are supposed to do what they do.

Now, as for airways. I was taught to go w/ an OP, if no gag A) insert NVA (combi or what have you) or B) get an ET down there. Another part that makes a lot of sense, if you're intercepting a basic squad and they have a combi in & its working LEAVE IT IN. Just because you can doesn't mean you should kind of mentality. Plus, you already have a secured airway. Granted you'll have times that this is the best option. As a case & point of just because you can doesn't mean you should: when we were using the iStan about 90% of people were throw for a loop when the pt had poor O2 sats, dimished resp, and all the signs of respiratory arrest. The 90% who got screwed up dropped a tube in the pt only to find out there were diminished breaths on one side. Pull back the tube a bit & they lost it. Why? The pt got a tension pneumothorax from trauma that no one looked for. So it all goes back to a great EMT making a good medic. Gadgets should never be substituted for training. Something will always fail you and its knowing how to work w/o that will save your ass (or your pt). Like I've said before, I'm still new at the medic thing.

Posted: 8/25/2010 9:20:45 PM EDT

[#34]

when i practice needle decompressions on myself, is the 2nd intercostal between the clavicle and the rib or one space further down?

Posted: 8/25/2010 9:38:41 PM EDT

[#35]

Quoted:

Quoted:

Miller or Mac blade for intubation?

Mac for me.

Mac on most adults. Miller for obese adults and kids.

Posted: 8/25/2010 9:40:38 PM EDT

[#36]

Quoted:

Quoted:

Do Paramedics crave donuts like LEUs or do they go for the fruit cups?

EMTs I know go for sandwiches and energy drinks.

And 'code 3 burritos.'

Posted: 8/25/2010 9:42:54 PM EDT

[#37]

Quoted:

Quoted:

.45 expanding. Dont ask I have seen worse. and 223 in heavier than 55 Grn

Quoted:

9mm or .45?

I know first hand that if you put a 270 under your chin but you fail to get it at the right angle, it will very effectively remove your entire face. And you will live through it.

Not something I had ever thought of before.

I would think living through this would be worse than death.

It's actually a more common occurance than you would think. Rifles barrels tend to be long. People extend their neck up and over the barrel tilting their head back so that the barrel is actually pointing at their nose instead of their brain. Yes it's horrible, yes it's bloody, yes they know everything that is going on, yes eyeballs look weird when they just outside your ear. And yes, if life was difficult enough for you to attempt suicide, going around looking like the guy from that Cher movie Mask doesn't make it easier.

Transported a kid who took out most of his jaw/maxilla by getting the wrong angle under his chin. He was conscious and suctioned his own mouth the entire ride. (Transfer from an outlying hosp to the trauma center)

Posted: 8/25/2010 9:44:23 PM EDT

[#38]

Quoted:

People who ask the "What's the worst thing you've ever seen?" question don't know it, but they don't want the real answer. SIDS babies, shaken babies, dead children, nearly dead children, bloody mess traumatic arrest pedi patients, raped children, abused, starved or intentionally burnt children are the worst.

Add parental stupidity as the compounding reason for any of the above. Dream that had only someone jammed a hot soldering gun into said moron parent's genitals prior to them procreating it all never would have happened.

Truth. Kids in pain.... gets me every time now. That and sweet elderly people who are all alone and sick.......

Posted: 8/26/2010 3:48:33 AM EDT

[#39]

Quoted:
Why do people who have been "feeling sick" for two weeks wait until 3:00am to decide they need to call 911 to be transported to the hospital?

Either they cant sleep or they figure it is the slowest time in the ER. If you figure out that you may get a nobel prize.

Posted: 8/26/2010 3:53:39 AM EDT

[#40]

I dont think this described you by your reply I stated Health Care. When you go to the ER do you pay for your services? This is what I said "
Diabetic 300 pound person who smokes and goes to the ER instead of a regular MD and is on medicaid and you get the idea.

I cant scream loud enough that those that cant afford health care should not get it . Im sorry when you are unemployed you sit at home collect food stamps,live in HUD housing, and have medicaid for you and your 5 kids you dont lose any weight. The proverbial "titty" needs to come out the mouth.

Quoted:

Quoted:
In your opinion, what kind of toll will obesity and diabetes take on this country?

The area I live in is one of the worst for DM1 and DM2 which is insulin and non insulin dependent diabetes. Obesity is also a problem as food is the main part of our culture. Race also predisposes some of the population. Diabetics are at higher risk of cardiac problems earlier in life. Just imagine a Diabetic 300 pound person who smokes and goes to the ER instead of a regular MD and is on medicaid and you get the idea.

I cant scream loud enough that those that cant afford health care should not get it . Im sorry when you are unemployed you sit at home collect food stamps,live in HUD housing, and have medicaid for you and your 5 kids you dont lose any weight. The proverbial "titty" needs to come out the mouth.

I work and have for the past 15 years. I am a 30 year old mother of 2 with several health problems. I have never smoked, drank, or done drugs. I have undifferentiated connective tissue disease (auto-immune disease) and chronic back issues from a failed back surgery. I also have SVT with rates that go to 180+ at rest. I need medications that I cannot take because I cannot afford the monthly labs that go along with the medications. When I become extremely sick I have no choice but to go to the ER. Insurance through my job is $1000 a month with high deductible and pre-existing conditions. I HAVE NO INSURANCE. I CANNOT AFFORD HEALTH INSURANCE.
I do not have Medicaid, food stamps, or any .gov assistance. So I guess I should not be able to get healthcare and I should just die and/or suffer right? Not everyone who does not have insurance is a lazy sloth. I work my ass off day in and day out just to make it. I am sick every day and have no energy. Could I qualify for disability, YES. Instead I choose to work to provide for my family despite how horrible I feel.

Posted: 8/26/2010 3:55:13 AM EDT

[#41]

My job is paid for by people making mistakes either long term or acute. Hospitals would not exist if not for Darwin. I never really felt bad.

Quoted:
I "Retired" after 15 years from EMS.
My question is do you ever feel bad for interfering with natural selection?
I could no longer feel ok with helping the incurably stupid every day all day and had to move on. And that was by far the greatest portion of my patient load.

Posted: 8/26/2010 3:58:00 AM EDT

[#42]

Quoted:

I dont think this described you by your reply I stated Health Care. When you go to the ER do you pay for your services? This is what I said "

Diabetic 300 pound person who smokes and goes to the ER instead of a regular MD and is on medicaid and you get the idea.
I cant scream loud enough that those that cant afford health care should not get it . Im sorry when you are unemployed you sit at home collect food stamps,live in HUD housing, and have medicaid for you and your 5 kids you dont lose any weight. The proverbial "titty" needs to come out the mouth.

Quoted:

Quoted:

In your opinion, what kind of toll will obesity and diabetes take on this country?

The area I live in is one of the worst for DM1 and DM2 which is insulin and non insulin dependent diabetes. Obesity is also a problem as food is the main part of our culture. Race also predisposes some of the population. Diabetics are at higher risk of cardiac problems earlier in life. Just imagine a Diabetic 300 pound person who smokes and goes to the ER instead of a regular MD and is on medicaid and you get the idea.
I cant scream loud enough that those that cant afford health care should not get it . Im sorry when you are unemployed you sit at home collect food stamps,live in HUD housing, and have medicaid for you and your 5 kids you dont lose any weight. The proverbial "titty" needs to come out the mouth.

I work and have for the past 15 years. I am a 30 year old mother of 2 with several health problems. I have never smoked, drank, or done drugs. I have undifferentiated connective tissue disease (auto-immune disease) and chronic back issues from a failed back surgery. I also have SVT with rates that go to 180+ at rest. I need medications that I cannot take because I cannot afford the monthly labs that go along with the medications. When I become extremely sick I have no choice but to go to the ER. Insurance through my job is $1000 a month with high deductible and pre-existing conditions. I HAVE NO INSURANCE. I CANNOT AFFORD HEALTH INSURANCE.

I do not have Medicaid, food stamps, or any .gov assistance. So I guess I should not be able to get healthcare and I should just die and/or suffer right? Not everyone who does not have insurance is a lazy sloth. I work my ass off day in and day out just to make it. I am sick every day and have no energy. Could I qualify for disability, YES. Instead I choose to work to provide for my family despite how horrible I feel.

I was responding to the part in red and also pointing out that just because you cannot afford healthcare does not mean you fit into the above category. If you were only describing those certain types of people then I misunderstood what you were trying to say.

I get just as ticked off at those who are welfare leaches and misuse the system. I could not get Medicaid unless I was pregnant or a single mother of 10. It would not matter if I was on my death bed.

Posted: 8/26/2010 3:58:20 AM EDT

[#43]

Did you see the ten year AHA study on continued CPR and "priming the pump" It measured mmHG during compressions and showed the large drop when CPR was stopped and how long it took to attain that pressure again.? I agree on some points that we work a lot of people that we cant save. ETCO2 is a pretty good indicator also. I disagree on EZIO. Flow rates have been proven by CTA scan to be equal or better when used with pressure infusion.

Quoted:

Quoted:
Rumors are that the NREMT is going to update the prehospital care curriculum soon. Have you heard anything about this and do you think there will be big changes if this occurs?

PHTLS has madea resurgence recently. Some things are being reviewed such as Inital IV being IO instead of IV , intubation may be restricted more and the LMA /King/ Combitube pushed more( I think thats bullshit) due to paramedics taking too long to intubate. We are trying a new type of CPR here that calls for continued CPR and less demand on Ventilations and we are seeing improvement already.

Kings sound retarded to me. I mean, ok, we insert the airway. Oh crap, its too deep. Alright, pull back a little...crap its displaced. Ok, now we have to re-insert and cause more trauma to the upper airway/mouth. It you're going to go with a non-visualized airway then I'm all about the combitube. That all said, intubations are great if you can do it right the first time. The Lucas and Autopulse stuff is going to make CPR easier (if they go into use w/ everyone). Then again, this is all from someone who is still wet behind the ears when it comes to EMS.

The autopulse is the cat's ass. Doing quality compressions while moving the patient from the call location to the hospital without stopping is a huge improvement.

Autopulse is a solution looking for a problem. If the patient still needs compressions by the time you get to the hospital, all we are doing is wasting epinephrine, and putting ourselves needlessly in danger. Three rounds of drugs in the house, if no improvement confirm asystole in 3 leads, call coroner. Go inservice and pick someone up that you can actually help.

IO's have a place but it shouldn't be a first line vascualar access. Drop and external jugular and move on. Can't find it? Learn where it is and stick it...you don't have to see it to place it. LMA/Combi/Kings are solutions to piss poor education and continued training. (The King is a fine airway in tactical situations) We should be spending less time in school learning about how to deal with our feelings, and learning what the strongest knot is, and learning the anatomy of the upper airway, and how to handle difficult and crash airways. And before we even consider advanced airway why don't we pull out a BVM, drop an OPA or an NPA or even better drop both, and bag them.

We should be spending more money on training, not gadgets to improve care. Despite all the extra bullshit we carry on the truck. As a percentage we are not saving any more lives than we were 30 years ago.

OP....sorry for the hijack and rant.

Posted: 8/26/2010 4:00:00 AM EDT

[#44]

Yes

Quoted:

Quoted:
I have found a checkbook and a few cheetoes under a titty the size of your head.

You made me spit on my monitor with that one. lol. You didn't really find that under a titty did you?

Posted: 8/26/2010 4:00:56 AM EDT

[#45]

Agh a ricky rescue. No I dont but in some small areas they do. hey sometimes they help and sometimes they dont. I have a complex about phones ringing and pages. It gives me anxiety

Quoted:
Do you wear your pager 24-7 even when you are off duty and cant possibly be of any service?
Ive seen this done a lot around here and wondered if its mandatory or they are just demanding attention when it goes off, they listen, then decide to not respond.

Posted: 8/26/2010 4:04:09 AM EDT

[#46]

Pain mgmt 4 Mg initial followed by 2 mg up to 10 mg total. then call for orders. Has to be an isolated extremity fx. Versed for Facilitated intubation is 2.5 mg , Seizures 2.5 up to 10 and sedation also. Also have to call after. We do have RSI with Roc and Succ for CCT/Flight medics in place.

Quoted:
whats your dosing amount and time interval for versed and morphine (or do you use something else)

I do anesthesia, and I spoke with a paramedic once who relayed their intervals and it was impressive how much you gave not waiting at all for peak effect

Posted: 8/26/2010 4:05:00 AM EDT

[#47]

Mac 4

Quoted:
Miller or Mac blade for intubation?

Posted: 8/26/2010 4:06:05 AM EDT

[#48]

Depends on how im feeling when I get to work. Dispatchers play a large role in my night. I can handle just about any call but the dispatcher can make or break my night.

Quoted:
What (if anything) about the job stresses you out? How often does this happen?

Posted: 8/26/2010 4:09:04 AM EDT

[#49]

So how would one go about getting a parasite in their eye or what would I have to do or neglect to get one there?

What king of parasite are we talking here, worm, mite, octopi?

Posted: 8/26/2010 4:10:23 AM EDT

[#50]

No no. I hate the< LEECHES> You and I are one the same page. As long as you hold on to a job I would gladly pay your bills. You make me proud that you try . I also have runs of SVT and psoriasis so bad I have arthritus. I am lucky enough to have helth insurance at work.

Quoted:

Quoted:
I dont think this described you by your reply I stated Health Care. When you go to the ER do you pay for your services? This is what I said "
Diabetic 300 pound person who smokes and goes to the ER instead of a regular MD and is on medicaid and you get the idea.

I cant scream loud enough that those that cant afford health care should not get it . Im sorry when you are unemployed you sit at home collect food stamps,live in HUD housing, and have medicaid for you and your 5 kids you dont lose any weight. The proverbial "titty" needs to come out the mouth.

Quoted:

Quoted:
In your opinion, what kind of toll will obesity and diabetes take on this country?

The area I live in is one of the worst for DM1 and DM2 which is insulin and non insulin dependent diabetes. Obesity is also a problem as food is the main part of our culture. Race also predisposes some of the population. Diabetics are at higher risk of cardiac problems earlier in life. Just imagine a Diabetic 300 pound person who smokes and goes to the ER instead of a regular MD and is on medicaid and you get the idea.

I cant scream loud enough that those that cant afford health care should not get it . Im sorry when you are unemployed you sit at home collect food stamps,live in HUD housing, and have medicaid for you and your 5 kids you dont lose any weight. The proverbial "titty" needs to come out the mouth.

I work and have for the past 15 years. I am a 30 year old mother of 2 with several health problems. I have never smoked, drank, or done drugs. I have undifferentiated connective tissue disease (auto-immune disease) and chronic back issues from a failed back surgery. I also have SVT with rates that go to 180+ at rest. I need medications that I cannot take because I cannot afford the monthly labs that go along with the medications. When I become extremely sick I have no choice but to go to the ER. Insurance through my job is $1000 a month with high deductible and pre-existing conditions. I HAVE NO INSURANCE. I CANNOT AFFORD HEALTH INSURANCE.
I do not have Medicaid, food stamps, or any .gov assistance. So I guess I should not be able to get healthcare and I should just die and/or suffer right? Not everyone who does not have insurance is a lazy sloth. I work my ass off day in and day out just to make it. I am sick every day and have no energy. Could I qualify for disability, YES. Instead I choose to work to provide for my family despite how horrible I feel.

I was responding to the part in red and also pointing out that just because you cannot afford healthcare does not mean you fit into the above category. If you were only describing those certain types of people then I misunderstood what you were trying to say.

I get just as ticked off at those who are welfare leaches and misuse the system. I could not get Medicaid unless I was pregnant or a single mother of 10. It would not matter if I was on my death bed.

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