In honor of the most awesome SDN thread: Things I Learned from My Patients (which can be found in the EM Residency Forum)....

I thought we should all share a few of the tidbits of knowledge that we have acquired during our EMS experiences. So don't be shy and don't violate HIPPA, but please tell us what you have learned!

I'll start with something I posted in the EM thread....

If you and your two friends decide to have a little party one December evening in your 3rd floor attic apartment and one of those friends is occupying the bathroom; it is not a good idea to climb out on the roof of the house in the middle of an ice storm to take a leak. This could result in falling off the roof with your penis hanging out. If this does occur, be sure to ask the cop if you will be arrested. He will tell you that he can't arrest people just for being stupid. The EMS crew will try very hard not to laugh as we backboard you and give you a lift to the ED with a Fx ankle and your penis still hanging out. (We weren't going to put it back in!)

I have learned why unstable people should not self medicate.

We need to merge these two threads :) I was writing on mine, before I was able to hit Post a 911 call came in :D, then your's posted...

Someone merge 'em!

any call that comes in at 3 am from a nursing home for a code 1 transport, no equipment needed, will be a cardiac arrest. if you bring in the equipment you can scare the call into being nothing. if you forget a single piece of critical care equipment it will be the worst call you've ever been on....be warned
case in point: code 1 transfer, no equipment for possible pneumonia...actual pt: decompensated cardiogenic shock in 90 yr old full code pt with hypotension requiring dopamine drip to keep bp at 60 systolic.....

Also, would someone please alert the Nursing Staff at nursing homes that:


If your patient is Cold, CLammy, unresponsive, and has AGONAL breathing, IT IS NOT SUPPORTIVE OF LIFE...

and...

Proper treatment is **NOT** 2L O2 ON NASAL CANULA!!!

Originally posted by Tas
Also, would someone please alert the Nursing Staff at nursing homes that:


If your patient is Cold, CLammy, unresponsive, and has AGONAL breathing, IT IS NOT SUPPORTIVE OF LIFE...

and...

Proper treatment is **NOT** 2L O2 ON NASAL CANULA!!!

or 2L on a simple face mask:scared: :scared:

OR 0 L BY NRB MASK NOT HOOKED UP TO ANY O2 SOURCE....
AND IF THE IV IS INFILTRATED DON'T FORCE A WHOLE LITER IN WITH AN IV PUMP.....
AND DON'T WAIT A WEEK TO MAKE SURE IT REALLY IS UROSEPSIS BEFORE YOU CALL....IT IS
ALSO ON A SEPARATE NOTE...IF YOU ARE A POST DVT PT ON COUMADIN DO NOT PLEASURE YOURSELF RECTALLY WITH THE WRONG END OF THE SCREWDRIVER AND THEN GET DRUNK AND TAKE A HOT TUB....YOU WILL PROBABLY BLEED OUT.....

If I decide to kill myself I will not try

....mixing ant poison and beer

....drinking liquid potpourii

....to chop my own hands off with a knife

.... to set myself on fire

..... to hang myself over a door the same height that I am including the length of the rope

.....to take ibuprofen, aceteminophen or any other over the counter medicine.

....by taking a handful of antibiotics


....or laxatives




:eek: :eek: :eek:

how about this...

If you want off work, call the ambulance (911 obviously), after it gets there, sign the refusal form and send them on their way.

30 minutes later, call 911 back and tell them that the crew forgot to leave your work excuse and could they please bring it by...

*smack head*:idea:

If you pull a little skin off your chapped lips and they start to bleed make sure you call 911 and have an ambulance sent emergent for "bleeding from the mouth".

Please...if you pull something doing the splits in your apartment at 3am, please please wake me and my crew assist you in going to the hospital. Especially when you have 5 other friends over at the same time. Then bitch when we go to immobilize you when we start treating you.

Something I learned on the ambulance...........

When you have a leadfoot EMT driving, it's the middle of a thunderstorm, and you are sitting in the back on the bench with the medic, HOLD ON! or you will end up in the lap of said medic when the EMT misses the stop sign.


When you call the ambulance at 3 am for your stomachache, be sure to invite 30 of your relatives over, none of which speak English, and gradually let them trickle in through every crevice in the apartment.


after you walk into the hospital, immediately throw yourself down on the floor in triage and moan saying you can't walk so that we have to wheel the gurney out to get you. and they walk out 20 minutes later.

Originally posted by lytesnsyrens
Something I learned on the ambulance...........

When you have a leadfoot EMT driving, it's the middle of a thunderstorm, and you are sitting in the back on the bench with the medic, HOLD ON! or you will end up in the lap of said medic when the EMT misses the stop sign.

:laugh: thats my brother whose the leadfoot EMT driver!!!:laugh:

Originally posted by SMW83
:laugh: thats my brother whose the leadfoot EMT driver!!!:laugh:

is that who that was???? tell him to knock it off! i don't like sitting in the medics and/or patients lap. lol

it was actually kinda funny. :D i was airborne for a few seconds.

I was thrown across the back of a rig once many years ago thanks to a car that ran a red light. I always wear my seatbelt in back unless I am doing CPR or up moving around to get equipment.

I have also learned on the ambulance that if you are drunk and flip your car onto its roof, it is not a good idea to ask the EMTs and the police officer to help you flip the car back over 'before the cops get here'!

The above-mentioned was a young male who also suffered from the "I am drunk and obnoxious - you are a female-EMT- don't you find me attractive" syndrome. Yes, the only reason I became an EMT was to meet winners like you! What is it about young guys that get drunk, wreck their cars, and think "boy, I'll bet she thinks I'm HOT!" Just a note - when I am checking out your arm I am looking for a vein to stick a needle into - I am not admiring your muscles so please do no flex. It makes it much more difficult to start the IV and draw bloods.

I'm sure I'll come up with more later...

What is said in the rig, stays in the rig, (unless you are working with x, y, or z).


It's inevitable that the worst snow storm of the year comes on the day of your shift and hits 30 minutes before you are to get off (and working private, where the dispatcher is 2 hours behind his calls and didn't think ahead of time that it is going to snow...).


The best way to learn about a city and its people is to serve the city and ride around in an ambulance.


Lifting is all about communication, proper form, and using your head (I'm 105 pounds and was able to lift people almost 3x my weight).
Here's an example of using your head...we got called for a lift assist at a wound care clinic for a patient I've been able to handle before. I knew that the patient could slide over from the exam table to the cot with the cot all the way up, so that there was no need to lift the cot from a lower position.


Falling asleep and leaving the driving to your partner can make you end up in Indiana when you wake up ;) and not having an answer to "what's taking so long" from the dispatchers.

Originally posted by PluckyDuk8

Falling asleep and leaving the driving to your partner can make you end up in Indiana when you wake up ;) and not having an answer to "what's taking so long" from the dispatchers. [/B]

Private company, non emergency, what?s wrong with a little deserved sleep.

The dispatchers DO think ahead. They just don?t care about YOUR extra curricular life to get you home on time.

:love:

I said it before, but...every patient starts at 250lbs, and gains 50lbs for every floor higher you go.

Another...if you go to a nursing home, and the patient is C/A/O x3, there is NOTHING WRONG with signing them off, if they don't want to go...and it's always a laugh to call in to the dispatcher with the "Code 4 with the 'x' ", for your private call.

I began to use a term with my partners called A&OxAtivan when ever describing pt?s from NH?s. It smoothly defines the unique alertness ?assigned? to them by the nurses. (I almost used it with a frustrating Medical Director. That would have been tough to explain.)

Why information about your pets assists me in establishing your baseline mental status....

What's that noise? Oh, that's the goat that lives in the kitchen....

Quack! Quack! Oh, there's duck on the chair in the living room! That's too bad he doesn't go outside at all because he certainly isn't housebroken..... (different house than the one the goat lives in)

But I can't go to the hospital....I have no one to feed my pet mongoose. You have a pet mongoose, sir? Yes, it is to protect me from the snakes!!!! Oh, so that is why all the doors and windows are taped shut - to keep the snakes out. Yes, and my mongoose needs fresh Perrier water and cat food every day! (Imaginary mongoose and snakes - real cat food and Perrier water in little dishes)

When on a call for respiratory distress it is unfortunate if the paramedic accidently bumps the mounted fire extinguisher and it turns on. Most of it goes into his boot, but the rest creates quite a mess in the ambulance and adds a whole new element to the patient's declining respiratory function. Open the windows and proceed to the hospital. Upon return, do NOT use a mixture of water and bleach to clean up the fire extinguisher chemical residue in the back of the ambulance. This will create a large cloud of hazardous gas!

Not me, but I was on the crew and the EMT who used the bleach was a chem major in college.

Things I learned:

Wash your crotch at least once a week so when EMTs pick you up the floor they don't faint.

Make sure you weigh less than the stretcher's max limit. Saves the fire fighters from destroying half your house

Originally posted by lytesnsyrens
Something I learned on the ambulance...........

When you have a leadfoot EMT driving, it's the middle of a thunderstorm, and you are sitting in the back on the bench with the medic, HOLD ON! or you will end up in the lap of said medic when the EMT misses the stop sign.


When you call the ambulance at 3 am for your stomachache, be sure to invite 30 of your relatives over, none of which speak English, and gradually let them trickle in through every crevice in the apartment.


after you walk into the hospital, immediately throw yourself down on the floor in triage and moan saying you can't walk so that we have to wheel the gurney out to get you. and they walk out 20 minutes later.

This leadfoot took a turn a little to fast ans caused me to slam my shoulder into the corner of the housing for the rig O2. I asked him to slow down but this fell on deaf ears. He took another turn too fast and threw me across the rig and I landed, face first into the cleavage of the patient's very hot wife. I apologized to the patient and his wife and thanked my driver

To the Nursing home "nurses"

RE: Several things

1) A person who is very hot to the touch, does NOT have a normal temperature

2) Patients in wheelchairs that disappear eventually turn up at the bottom of the stairs

3) A person who is in cardiac arrest does not require your changing their diapers at that time

4) 4 little nurses, each weighing 100lbs, cannot safely place a 300lb man on the floor from the bed during a cardiac arrest

5) When you see that your patient stopped breathing at 3am, it is not necessary to call the doctor, who will tell you to place them on a 2lpm NRB. Then call EMS at 6am because they are still not breathing (unless it is my shift)

6) a person with a blood sugar level of 400 is not normal

7) a quick peice of advice, if you do not need a stethascope to determine pulmonary edema, sit the person up. It really helps

8) Getting off the boat from the carribean and putting on scrubs does not make you qualified to be a nurse, or a treee surgeon for that matter

and the final peice of advice:

THE ONLY USE YOU HAVE TO ME IS TO GIVE ME THE PAPERWORK AND TELL ME HOW YOU FOUND THEM. OTHER THAN THAT YOU ARE AS USELESS AS THE MASK YOU PUT ON THEM. NOW GO AN WIPE SOME ARSES.

Originally posted by EMT2ER-DOC
To the Nursing home "nurses"

RE: Several things

1) A person who is very hot to the touch, does NOT have a normal temperature

2) Patients in wheelchairs that disappear eventually turn up at the bottom of the stairs

3) A person who is in cardiac arrest does not require your changing their diapers at that time

4) 4 little nurses, each weighing 100lbs, cannot safely place a 300lb man on the floor from the bed during a cardiac arrest

5) When you see that your patient stopped breathing at 3am, it is not necessary to call the doctor, who will tell you to place them on a 2lpm NRB. Then call EMS at 6am because they are still not breathing (unless it is my shift)

6) a person with a blood sugar level of 400 is not normal

7) a quick peice of advice, if you do not need a stethascope to determine pulmonary edema, sit the person up. It really helps

8) Getting off the boat from the carribean and putting on scrubs does not make you qualified to be a nurse, or a treee surgeon for that matter

and the final peice of advice:

THE ONLY USE YOU HAVE TO ME IS TO GIVE ME THE PAPERWORK AND TELL ME HOW YOU FOUND THEM. OTHER THAN THAT YOU ARE AS USELESS AS THE MASK YOU PUT ON THEM. NOW GO AN WIPE SOME ARSES.

I hope you are just talking about nursing home nurses, in which case I'll agree. If not, I'll have to add my own list of EMT anecdotes

the "to" line addresses those nurses

Originally posted by EMT2ER-DOC
To the Nursing home "nurses"

RE: Several things

1) A person who is very hot to the touch, does NOT have a normal temperature

2) Patients in wheelchairs that disappear eventually turn up at the bottom of the stairs

3) A person who is in cardiac arrest does not require your changing their diapers at that time

4) 4 little nurses, each weighing 100lbs, cannot safely place a 300lb man on the floor from the bed during a cardiac arrest

5) When you see that your patient stopped breathing at 3am, it is not necessary to call the doctor, who will tell you to place them on a 2lpm NRB. Then call EMS at 6am because they are still not breathing (unless it is my shift)

6) a person with a blood sugar level of 400 is not normal

7) a quick peice of advice, if you do not need a stethascope to determine pulmonary edema, sit the person up. It really helps

8) Getting off the boat from the carribean and putting on scrubs does not make you qualified to be a nurse, or a treee surgeon for that matter

and the final peice of advice:

THE ONLY USE YOU HAVE TO ME IS TO GIVE ME THE PAPERWORK AND TELL ME HOW YOU FOUND THEM. OTHER THAN THAT YOU ARE AS USELESS AS THE MASK YOU PUT ON THEM. NOW GO AN WIPE SOME ARSES.

Sorry man, I just take issue with this post. Some of the things you said were a little funny. BUT, you dont sound like the type that should be criticizing any other health care professionals.

I bet most people getting off that boat from the Carribbean can spell PIECE, CARRIBBEAN, not to mention STETHOSCOPE. If English is your native language you should be ashamed. Also half of the "several things" you listed dont even make sense. If you knew anything about a NRB mask, you would know they dont work at 2lpm.

peace

umm.. I think he was being sarcastic about the NRB @ 2lpm. Old EMS joke. And yes, to the other poster, I believe he was talking about nursing home nurses as they usually are the black sheep of the nursing family and again the butt of most EMS humor.

Originally posted by oudoc08
umm.. I think he was being sarcastic about the NRB @ 2lpm. Old EMS joke. And yes, to the other poster, I believe he was talking about nursing home nurses as they usually are the black sheep of the nursing family and again the butt of most EMS humor.


Yeah, my bad, I just have a compulsion to defend nurses - even though most of what I've read on these threads is true... The post just came a little too close to trashing all nurses (ass-wipers, etc.) There are good and bad in all areas..

I just am thankful there are people who are actually willing to work in ECF/SNF. I couldn't imagine it myself (pure torture).

If you are referring to nursing home CNA's and not RN's or LPN's, then fine, sometimes its granted. If not, then you should really appreciate those who do that which most of us are not willing to do (which I actually will attribute to CNA's as well), and whose education nowadays can take just as long as doctors.

Originally posted by beanbean
When on a call for respiratory distress it is unfortunate if the paramedic accidently bumps the mounted fire extinguisher and it turns on. Most of it goes into his boot, but the rest creates quite a mess in the ambulance and adds a whole new element to the patient's declining respiratory function. Open the windows and proceed to the hospital. Upon return, do NOT use a mixture of water and bleach to clean up the fire extinguisher chemical residue in the back of the ambulance. This will create a large cloud of hazardous gas!

Not me, but I was on the crew and the EMT who used the bleach was a chem major in college.

I don't see how CO2 and sodium hypochlorite can react that badly? CO2 is already in its oxidative state, and sodium hypochlorite is an oxidizing agent. Maybe there were other unknowns chemicals (such as NH3) inside the vehicle that reacted to the bleach. Or maybe the concentration was a little too strong, and the vehicle wasn't properly ventilated, since the fumes from bleach is pretty powerful

sorry for the tangent - gotta defend chem majors :)

Nothing against chem majors - she just wasn't thinking that night...she used the bleach full strength. I have no idea what reacted with what, but it was nasty. Fortunately, we were cleaning the rig with the bay doors open!

A good laugh was had by all after the fumes cleared!

More stories please! I know someone learned something new from a patient today. Share the knowledge!

Originally posted by medic8m
Sorry man, I just take issue with this post. Some of the things you said were a little funny. BUT, you dont sound like the type that should be criticizing any other health care professionals.

I bet most people getting off that boat from the Carribbean can spell PIECE, CARRIBBEAN, not to mention STETHOSCOPE. If English is your native language you should be ashamed. Also half of the "several things" you listed dont even make sense. If you knew anything about a NRB mask, you would know they dont work at 2lpm.

peace

I take it that you are apologizing for the NRB remark. I have been in EMS long enough to KNOW the amount of O2 each mask can take.

As for my spelling, this is what happens when you do not spell check due to being in a rush since my timer just went off for my experiment to be completed properly. There are plenty of spelling errors on these boards and if you look you will find them. So, no need to have an issue with spelling because this is not a dictation test.

Everything on that list is an issue I PERSONALLY experienced with the so called nurses at the various nursing homes in my district. You would also have contempt for these rejects if they told a family that you and your crew were responsible for the death of their family member because we caused a laceration in the back of his head while doing CPR. Please note #4 on my list as to the cause of this head laceration.

nuff sed

Originally posted by EMT2ER-DOC
I take it that you are apologizing for the NRB remark. I have been in EMS long enough to KNOW the amount of O2 each mask can take.

As for my spelling, this is what happens when you do not spell check due to being in a rush since my timer just went off for my experiment to be completed properly. There are plenty of spelling errors on these boards and if you look you will find them. So, no need to have an issue with spelling because this is not a dictation test.

Everything on that list is an issue I PERSONALLY experienced with the so called nurses at the various nursing homes in my district. You would also have contempt for these rejects if they told a family that you and your crew were responsible for the death of their family member because we caused a laceration in the back of his head while doing CPR. Please note #4 on my list as to the cause of this head laceration.

nuff sed

Its cool dude, I come in contact with incompetent nurses all the time, i feel your pain. I just ignore half the things they say in report and do my own assessment. Nursing homes are dismal places for the most part. Nursing home nurses are probably the equivalent of those EMTs that come to transport patients to nursing homes. They wander up to me with the chart and say "this patient was admitted with sin-cope. Whats sin-cope?"
You can't tell me all EMTs have it together. Most of what we learn comes from experience.

Anyway, I find patients say/do much more hilarious $hit than any workers.

no worries

4) 4 little nurses, each weighing 100lbs, cannot safely place a 300lb man on the floor from the bed during a cardiac arrest

Why on earth would you PURPOSELY move a 300 lb nursing home patient to the FLOOR of all places......intubation is easier in the bed....CPR is easier (just flop a backboard or CPR board under them)........at least just move them parallel to the cot.

I can't imagine Moving a fat man to the floor on purpose! jeeeeshh

please don't take offense to this......i'm just one of those medics that HATES lifting at all costs.

later

Originally posted by PluckyDuk8
If you are referring to nursing home CNA's and not RN's or LPN's, then fine, sometimes its granted. If not, then you should really appreciate those who do that which most of us are not willing to do (which I actually will attribute to CNA's as well), and whose education nowadays can take just as long as doctors.

Sorry but I'm not referring to CNA's. I am specifically referring to nursing home nurses. The overwhelming majority of the most clueless indivduals I run into in nursing homes have the letters LPN or RN on their name badge. CNA's almost never do anything other than help transfer the patient. They refer us to the nurses for medical information.

However, let me say that this is in no way saying that I and other medics don't appreciate the function those nurses perform.

What is being discussed is the shocking lack of common sense and medical knowledge displayed by those who, according to their designation anyways, went to nursing school.

They seem to be retain skill in "basic nursing care" (i.e. ADL care, long-term therapy, etc.), however, are as a whole, highly lacking in anything other than basic assessment, recognition of impending problems, and common sense things, like sitting patients up who can't breathe due to pulmonary failure.

Were these the exception rather than the rule, I would be the first to speak up in defense, however as someone who has seen this day in and day out for 7 years, I am, as are the vast majority of experienced field providers on this site, sorry to say that the reverse is true.


Oh, and by the way, no nurse's total education takes longer than a doctors total education.

To become a doctor takes an undergraduate degree in alomst every case (4-5 yrs), medical school (4 years) and a minimum of an 1 year internship just to be a GP (but who really does that anymore), so in that case add two years for a FP residency (to total three years res.)

That adds up to 11-12 years minimum.

What nurses program was it exactly that takes anywhere close to this long?

ARNP was the longest nursing program the last time I checked which requires a BSN and then 48-52 hrs to obtain the nurse practioner masters degree.

So 5-6 years vs. 11-12.

Hmm...

Originally posted by oudoc08
Sorry but I'm not referring to CNA's. I am specifically referring to nursing home nurses. The overwhelming majority of the most clueless indivduals I run into in nursing homes have the letters LPN or RN on their name badge. CNA's almost never do anything other than help transfer the patient. They refer us to the nurses for medical information.

However, let me say that this is in no way saying that I and other medics don't appreciate the function those nurses perform.

What is being discussed is the shocking lack of common sense and medical knowledge displayed by those who, according to their designation anyways, went to nursing school.

They seem to be retain skill in "basic nursing care" (i.e. ADL care, long-term therapy, etc.), however, are as a whole, highly lacking in anything other than basic assessment, recognition of impending problems, and common sense things, like sitting patients up who can't breathe due to pulmonary failure.

Were these the exception rather than the rule, I would be the first to speak up in defense, however as someone who has seen this day in and day out for 7 years, I am, as are the vast majority of experienced field providers on this site, sorry to say that the reverse is true.


Oh, and by the way, no nurse's total education takes longer than a doctors total education.

To become a doctor takes an undergraduate degree in alomst every case (4-5 yrs), medical school (4 years) and a minimum of an 1 year internship just to be a GP (but who really does that anymore), so in that case add two years for a FP residency (to total three years res.)

That adds up to 11-12 years minimum.

What nurses program was it exactly that takes anywhere close to this long?

ARNP was the longest nursing program the last time I checked which requires a BSN and then 48-52 hrs to obtain the nurse practioner masters degree.

So 5-6 years vs. 11-12.

Hmm...



bsn 4-5 yrs same as any other undergrad plus 2 yrs for most masters programs or possible 2.5 for crna, also there are doctorates in nursing so add another year or 2 depending on specialty for those who have that degree, still it is obviously in no way equal to 10-12 yrs for MD but a 5 is a little short for a masters, more like 7 on average possibly more depending on specialty and 8 for doctorate quite possibly more depending on specialty. No comment on the rest of the issues, just shedding some light on the length of nursing education.

Originally posted by medic8m
Also half of the "several things" you listed dont even make sense. If you knew anything about a NRB mask, you would know they dont work at 2lpm.
Unfortunately, my husband has found nursing home patients, more than once, who were placed on a NRB @ 2lpm. And no, they don't work, which would be the problem. He also was called for a patient having "difficulty breathing," when he got there, he was told the pt. had a pulse ox of 52 and had been placed on a NC. When they got to the pt., she was very dead and had been so for a long time.

There really is an infinate amount of time one could spend on a nursing education - PhD is offered. However, the nurses that work at nursing homes most likely have 2 year AA degrees. This is the minimum education one needs to be licensed in most states. This is also the last place any nurse I know wants to work. Usually an RN or LVN will handle medications and dressing changes. CNAs do most patient care. The RN may only see the patient once a shift.

From fire & rescue magazine...


480 volts will NOT start your car, but it will stop your heart for good.

EMS responded to a man down in a cinema parking lot. Upon arrival they began CPR and got out the AED. After eventually giving up they started to get the full story from the bystanders. Apparently, the man left his lights on and lacking anyone to give him a jump with their car, removed the safety plate at the base of the parking lot light. He then proceded to remove the wire nuts off the wires feeding the light. He hooked up his jumper cables to those wires. onlookers said he never got a chance to try them on his car, the electricity flowed thru him as soon as he picked up his cables "lighting him up like a Christmas tree" as current flowed directly thru his chest.

Speaking of NRB masks... kind of a random question I've always wondered:

On airplanes they always give the "if cabin pressure should drop oxygen masks will fall" speech before the flight. The flight attendant always says that the reservoir bags will not inflate but that oxygen is flowing. So these bags must serve some other purpose than in NRB masks. Does anybody know what function the airplane mask reservoir serves?

Something to do with containing the oxygen in case of fire?? (seems far fetched but its all I can think of)

I'm not an expert on airplanes or oxygen use by any means, but I ..*cough* borrowed *cough* this from an out of date pan american flight instructors guide for a DC-10...

....

l5. Q. What is the function and purpose of the rebreather bag?

A. The first part of the exhalation is rich in oxygen and

thus is suitable for rebreathing and it passes down

into the bag where it mixes with the incoming oxygen.

The bag then becomes extended and the slight pressure

thus formed causes the remaining portion of the

exhalation, which is high in carbon dioxide content,

to pass out through the sponge rubber discs. The

advantages of the rebreather bag are as follows:

(a) Rebreathing the oxygen rich portion of each

exhalation greatly increases the effective use

of the oxygen available.

(b) The carbon dioxide conserved by the bag

stimulates breathing.

(c) The humidity conserved by the bag prevents

dryness and soreness of the throat.

....

I know that isn't as detailed answer as I'd like, but it might answer some questions...

Thanks Tas - Makes sense!

Now return that flight manual before the feds get suspicous

1. CNA's at nursing homes double NRB's as AMBU's.

2. If your kids had the flu, your husband had the flu, your sister had the flu, and now you have flu like symptoms... You have the damn flu!

3. The BS rating of the call increased exponentially with the number of fully functioning cars in the driveway!

4. Let the student's run the, "24 y/o female with Chest Pain." :rolleyes:

5. Always take chocholate to the pit boss/RN charge.

6. The most important Vitamine to have on the truck is Vit. H (haldol).

When treating the Acute pulmonary edema patient found lying supine in a filthy diaper on 1LPM O2 via simple face mask, it may be construed as bad form to throw a pillow behind the nursing station and say "use this next time, it's much faster."

Another thing I learned early on as a medic is:
if you are thinking about intubating a patient you probably should be.

Doctor+pulse oximeter+nursing home friday afternoon shift= abuse of the 911 system.

Not me, but I know the crew...

Responded to a report of a jet skier hit by a motor boat on the lake.

Arrive to find the male pt was pulled from the water into a small motor boat and brought to the dock near shore. Pt is still in the boat and has an obvious femur fx. EMTs, police officer, bystanders and equipment all on the dock....no wait, all in the lake! Yes, the dock collapsed sending everything and everyone into the cold water. Needless to say, they all reported it was a long soggy ride to the ED.

We gave each crew member a Suffield Ambulance Dive Team tee-shirt.:laugh:

Originally posted by medic8m
Thanks Tas - Makes sense!

Now return that flight manual before the feds get suspicous

:) No worries, everyone loves Tas, even feds! :)

Actually, I hope that I can study and get a pilots license after I get an MD. My buddy flies a Cesna(?) and it's the most incredible experience seeing things from up there.

Btw, would this be a "fed" smiley? :cool:

Dispatch: 40 yo female vomiting large quantity of blood

What I learned: If you decide to drink a bottle of RED wine to celebrate your 40th birthday, you are not vomiting BLOOD; you are vomiting RED WINE!!!!

By the way, the wine is probably what is causing your nausea as well!

By all means still insist upon EMS transport to the farthest hospital we transport to.

Never EVER cut a down coat in the back of the bus....otherwise you'll be breathing feathers for the next 2 months.... or MAKE your partner who cut it, clean it up...

The heavier you weigh, the higher the floor you live on.

It's ALWAYS "shift change" at the nursing home when they find the unresponsive patient....

"Don't throw out that BVM!" 'Why?' ask the medics "Cause we reuse it." reply the nursing home staff...

"Start your day with a D O A....doo dahh...doo dahh..." (or substitute M V A)

Drinking bleech won't kill you (quickly), but it'll give you a horrible case of GI distress

"So I drank a glass a water with 4 tablespoons of that stuff" (pointing to pure powdered charcoal). 'WHY?' "Cause I had chest pains."

"So i did some coke and I started getting palpitations, so then I took 40mg of valium (PO)" -'good job sez the ER doc, now i don't have to treat you'

more when i remember... +pity+

Thank you for the reminder on the down coats - I had forgotten about that one!

If you are a rich lady driving your BMW too fast while too drunk and crash, be sure to give all EMTs your bitchiest 'do you know who I am attitude'. When you puke all over your fur coat that probably cost more than my car, I will try to refrain from smiling.
Don't worry about the dry cleaning bill - we will just cut the coat right off with the trauma shears.

oh yeah! :

Don't play no: "My Neck, My Back, My Wallet" MVA injury with me... ur just gonna get the 2" tape right over your eyebrows.. :D

if you are in a minor mva in which your driver door is pinned shut and you have mild neck pain do not piss off the medics and degrade them when they stopped playing a perfectly good game of ping pong at 3 am to come help you. they will probably have the fire dept tear your brand new jaguar apart to c-spine you.

This is great! I didn't even know there was an EMS forum. I suppose my brain is too addled from breathing smoke back in the day.

Never allow a captain to start coding your patient because he was taking a radial pulse while you were taking a BP on the same arm. In fact if you have a captain in the back of your rig at all you've made an error somewhere along the way. One good way to get rid of them is to suggest that someone has cookies on the engine.

Here in Commerce City, a non-emergent response to a dog bite is actually a result of a police chase at 3am at 100+ mph, involving a rollover and taking out of a telephone pole. The dogbite part comes in when the carthief tries to run from PD after the above events and they have to send the K-9 after him to rip out a chunk of his arm.

btw, love this thread and this forum, good job guys keep it going.

This is great! I didn't even know there was an EMS forum. I suppose my brain is too addled from breathing smoke back in the day.

Never allow a captain to start coding your patient because he was taking a radial pulse while you were taking a BP on the same arm. In fact if you have a captain in the back of your rig at all you've made an error somewhere along the way. One good way to get rid of them is to suggest that someone has cookies on the engine.


I usually save it for chiefs, but CHAOS works for captains too (Chief has arrived on scene). Have him go talk on the radio to dispatch, or something.

dispatch for "patient not feeling well" = cpr soon to be in progress

I had a patient tell me at 0200 the other day that if I didn't transport her husband to Hospital X, instead of the usual Hospital Y, she'd take him by POV. Now why didn't she tell me that 20min before so I could've stayed in bed????

raDiOnut :cool:

"I had a patient tell me at 0200 the other day that if I didn't transport her husband to Hospital X, instead of the usual Hospital Y, she'd take him by POV. Now why didn't she tell me that 20min before so I could've stayed in bed????"

SOUNDS LIKE AN AMA, MY FAVORITE 3 AM COMPLAINT.
AMA= ADIOS MUTHA F***HA

Nurses, just like any other HCP or anyone period, come in good, bad and dangerous flavors. I responded to a floor code not too long ago and I started to intubate the patient when the nurse told me to stop. She said we had to move the patient to ICU before we intubated. I laughed politely because I thought she was kidding. When I kept going she yelled at me to stop. I said that I was not going to wait and that I was running the code and she said that if I did not "follow procedure" she was going to have all of her nurses stop assisting with the code. She also said that I, as a doc, was not allow to push drugs so I couldn't continue the code by my self. At this point I have intubated the patient and I asked the nurse, "Are you ------- crazy?" Fortunately the other nurses did what I said, not what she said and we resuscitated the patient and moved her to ICU (intubated). I walk out of the unit and meet up with the nurse and the nursing sup. The nurse is fuming and tells the whole story to the sup. The sup just stares at her for a second and looks at me and says, "Why don't you head back to the ER." As I wald away the sup says to the nurse, "Are you ------- crazy?"

This is the best thread I have read for a long time! I have been doing this for a few days and have to say, it is all true....

Another bad thing to do....

DISP nursing home for CP. Arrive to find 4 people in the room, all stating they have chest pain. Only one had it since this morning. The staff, as suaual have no idea about her, "The RN is getting everything together, she is normally really healthy", thanks.

Go though the questions, pt reports no allergies/history/some unk meds, monitor, line, drugs.

Start to leave and the RN come up and said "You know she is allergic to NTG"

As normal, the reaction the pt has is a HA and lower BP.

The appropriate statement to the pt is not "We are going to take you out of here before the nurses can do anyhhting else to try to kill you."
:meanie:

The sign at McDonlads Drive Thru doesn't actually mean "Drive Thru"! Stopping at the window usually does the trick and there is no need to plough your car into the checkout wall!

If I am going to hang myself by jumping out of the top of the barn, I am going to make sure the rope isn't so long that my feet hit the ground breaking both femurs and putting me in hospital for months!

Its a good idea to make sure you dont run out of fuel when trying to commit suicide by locking yourself in the garage with the vehicle running.

A&E staff dont take too kindly to me filling in a Patient report form for each personality of a schizophrenic! :)

Bumping this thread up!

Somebody has to have learned something on the ambulance these past couple of weeks.

I haven't learned anything on the rig because I haven't done any calls lately, but I have learned something in the ED on my elective:

If you are 95 yo, fall out of your wheelchair and get a small lac above your eye it is not necessary to prove to us that you are ok by doing wheelies in the ED hallway with your wheelchair. Actually, it will probably contribute to buying you a trip to the CAT scanner. :laugh:

To the nursing home staff:
If a wheelchairbound patient has been missing for several hours, start searching the bottom of every stairwekk, they will be there.

To the ER doctor:
Asking a patient who is boarded and collard if his neck and back hurtsprior to your removal of such devices, 2 minutes after we drop them off, gets placed in my report to protect MY ASS, not yours.

To the charge nurse:
We know you are very busy, who the hell do you think brings them in?

To the Lumberjack who just lost his leg:
Cutting down a tree that is 5ft in diameter at 9pm with no light, is not smart. There are clues to this: #1 the chain to your chainsaw breaks, #2 you have to cut in multiple places, #3 you light tiki torches to see what you are doing.

To the ASS who just exposed me to your blood by spitting at me:
Cops will beat the crap out of you for that too, at least in my town. Then when I have to clean your bloody face, I will make sure that it not only burns but is a little rough around the edges too.

To the idiot who refused to pull over for me while approaching the accident scene:
Uh, accident scene with injuries=lots of cops present. But you knew that since the cop walked up to your window and told you in a not so nice way to pull over because he wants to test his new pen and see how many tickets he can write for you.

If you're sitting in the ambulance at the drive through at Taco Hell at 1am on a Friday night and the dude in the truck in front of you doesn't move for over 15min, get pissed, turn on the siren a few times, and when there's no response walk outside and tap on the window. If you discover him passed out and slouched over with his foot on the brake and his truck in drive, call Fire to unlock the doors (aka smash the windows) and call PD so they can take him to the slammer for drunk driving. If you're still dumb enough to attempt to get some food at the Taco Hell after that (it being your fourth attemp that night), you're plain stupid and should probably just have your EMT drive you to the mental hospital down the street.

Funny things I've seen/heard:

1) Monk sets himself on fire. When the medics show up, with fire dept. on scene, monk is still engulfed in flames. Medic asks fire dept. to please put fire out. They respond no-can-do until police get here. :confused: Medic finally gets fire extinguisher out of ambulance and puts out monk herself. Pt. pronounced DOA by Medics.

2) Attn NH staff: If pt. has rigor mortis or lividity, please do not attempt CPR. And don't get mad at us when we pronounce the pt. dead.

3) Stepping on a toothpick does not qualify you for any type of medical attn. Especially mine.

4) Attn pregnant pts. You have 9 months to prepare for a ride to the hospital when labor begins. Unless the head is crowning or your water has broken, remember that cabs and buses also go to the hospital. :idea:

5) When the area is in the midst of the worst snow/ice storm in 50 years, please try and see if you can hold off on calling 911 for the abdominal pain you've had for 2 weeks. :thumbup:

6) Don't EVER play chicken with an ambulance. You will lose everytime. Also, after you've been shot or stabbed and are circling the drain, it is not the best time to give us a hard time. We didn't put you in the situation and are your only lifeline for the next 10-20 mins. And frankly, we still get paid no matter what your outcome is.

7) To all of you dispatchers who love to screw with the crews you don't like. We sometimes fantasize about you wrecking and it being our call. While we would never hurt you, it could make for a very rough day. :meanie:

8) First responders: Please avoid bandaging and wrapping the wound before we get there. Control the bleeding and let us deal with the bandaging. If not, we've have to take it off to look at it, then re-bandage it. Aaaggghhh!!

Thanks for letting me vent. :) :)

hey everyone,

i'm new to these forums and i thought i'd just introduce myself...here's my little contribution to this thread.

DON'T beat up your pregnant girlfriend, then go to the ER to get treatment for the hand you hurt while beating her up, and when we roll into the ER with your girlfriend in the back of the rig, DON'T pester the ER staff with questions about why she gets to be treated first.

...have gone to the P.D. booking or to jail for some dumb arse who has chest pain, is passed out, or can't breathe? Yeah, I have. In 5 years of doing it, I've NEVER had a prisoner with a legitimate medical problem. What do you know, you're getting booked for the crime you committed and all the sudden you get chest pain? You got arrested for shoplifting and now you're dizzy? Do you think going to the hospital will get you out of going to jail? Is the Pope muslim?
Last time I embarked on such adventure to the county jail for a 24 yo dyspneic male (held a knife to his mother's throat), I found a prisoner in a cell coughing and hacking, screaming for his asthma medications. The tipoff to his "legitimate" medical condition was that while I listened to him scream for a minute, he forgot that he was short of breath in all his rage. The rest was all downhill: clear and equal breath sounds, SpO2 98% room air, pink warm and dry, equal insp. and exp. phases, etc etc. To stop this guy from spitting all over the ambulance and screaming (my EMT and I both had a headache) I decided to try some of that experimental asthma medication on this dude and let my EMT attend. It's funny, nebulized Obecalp works wanders on bs'ers. Too bad Obecalp is nebulized normal saline. My physician advisor, on duty at the ER that night, chuckled on that one forawhile before he was finally able to tell me that this is unethical and I should probably hold off on Obecalp until it passes some more trials.
Obecalp, btw = Placebo backwards

I have actually responded to a legit call at the PD for a guest who had 'passed out'. This 18 yo kid had been taken in for suspicion of DUI. When he was walked over to the breathalyzer he passed out. The cops initially this kid was trying to get out of taking the test and they were pretty annoyed. Honestly, the kid's BP was something like 60/40. He was so completely freaked out about getting arrested he had a vasovagal reaction and hit the floor. He was white as a ghost, very diaphoretic and his pulse was thready and rapid. He wasn't even drunk, but being under 21 any alcohol in your system puts you over the legal limit.

Four years in rural Texas taught me:

1. If you are planning to run down your significant other, you might not want to drive your brand new car into your new mobile home: consider driving your old beater car instead - and avoid your house.

2. If you are using a box-cutter to open boxes, be sure to CLOSE it when you put it back into your apron pocket.

3. If you have driven your car into the ditch on your way out of the bar parking lot (on your way to another bar), do NOT ask the medics if they will get you a beer while waiting for the cops.

4. It is always appropriate to carry "special" shears on prom night and homecoming night. These decorated shears are only used to remove formal dresses from drunk high school girls in MVAs.

5. Swearing at the medics will result in overusage of tape in very delicate, hairy areas.

6. Do not complain about the bruise caused by your seatbelt when you are covered in the blood of the dead people in the car who weren't wearing a seatbelt.

7. All cases of priapism should be investigated, as it could be a symptom of spinal injury. But there really is a twenty-something kid out there who makes Dirk Diggler look like a mouse.

8. The correct answer for, "How much have you had tonight?" is ALWAYS "Two beers."

...before starting medical school...and I'm a bit nostalgic. 5 years in EMS have been good to me, teaching me lessons most 25 years olds don't have to learn. EMS has been my life during this time, and just as it has convinced me of my passion for medicine, it has also convinced me of my need to go on, pursue further education. As great as pre-hospital medicine is, it certainly has issues and limitations; however, I know that I'm a much better person for having been a paramedic, just as I will be a better physician because of my paramedic background.
Thank you to this awesome field, and thank you to all of you dedicated EMS folks out there. All the best to all of you

-alex

I was an EMT for 4 years in NC before med school. It was an interesting county to work in...half of the county was affluent and intellectual (being the home of UNC), the other half was very, very rural. I loved it, and I really missed it in med school. So here's some of what I learned.

If your 98-year old momma fell down and didn't get up 5 days ago, stopped "taking water" 4 days ago, got really cold 3 days ago (no matter how many electric blankets you put on her, or however many space heaters you put in the room. In August.), and now has roaches under said electric blankets, your momma does not need EMS care.

If your 89 year old, 92-lb husband fell in the middle of the night and has an obvious hip fracture, don't give him 3 percoset and then get mad at us when we pronounce him with altered mental status.

"Some dude" has got to be brought to justice. He keeps attacking people who were walking around, minding their own business in alleyways at 3am.

If you get a call to an 18 year old, drunk out of her mind college freshman, you will inevitably be working with someone who is a sympathetic puker.

I was also on the Swiftwater Rescue Team...here's something I learned from there:
Say there's been lots of rainfall in the past 2 months, meaning the rivers are all up, and now a hurricane is coming through. THIS IS NOT THE TIME TO TAKE THE CANOE OUT AND GO FISHING.

Repost of what I added to EM's thread...It actually belongs here more.
If you are a 450 pound female with shortness of breath and chest pain and a hx. of COPD and asthma it is best to decide not to take an ambulance because it is too expensive for you. The taxi driver you decide to take instead will like appreciate you collapsing while attempting to enter his taxi

This resulted in us arriving and finding her in asystole.

Well, at least she was street-level and not on the 5th floor of a walk-up.

Its sad when people don't realize how sick they really are. We had a 55yo guy code last night in my town - he hadn't been feeling well for a week but never went to get checked out.

Repost of what I added to EM's thread...It actually belongs here more.
If you are a 450 pound female with shortness of breath and chest pain and a hx. of COPD and asthma it is best to decide not to take an ambulance because it is too expensive for you. The taxi driver you decide to take instead will like appreciate you collapsing while attempting to enter his taxi

This resulted in us arriving and finding her in asystole.

I know everyone has a little gallows humor in this field, but damn -- the cab driver wont "appreciate you collapsing" and dying. The poor woman couldn't afford an ambuance and died. It isn't the first time. Sorry, this post just struck me as mean and pointless.

Long time no see Sweet Tea! It was great seeing you on THIS forum tonight! Thanks for all the back-up to 'J & A' on the other one. I checked the internet on A's screenname and found it disturbing to say the least.
I work in NC too (EMS). Sounds like the same county too. Hmmmm.... Anyway, good luck to you in med. school and take care! :D

Oetzi, you have a PM coming your way.

I know everyone has a little gallows humor in this field, but damn -- the cab driver wont "appreciate you collapsing" and dying. The poor woman couldn't afford an ambuance and died. It isn't the first time. Sorry, this post just struck me as mean and pointless.

I promise I meant no harm and I apologize. This call was in a country not in the u.s. where pretty much all ambulance calls are paid back by your insurance, and everyone is insured (and even so the ambulance ride is very cheap in comparison to america). She really wouldn't be paying a thing. I am sorry for the misunderstanding, I reread my post and truthfully I didn't mean it that way. I just meant to convey the irony in the call and that people should really listen to their bodies.

BUMP up this thread...I know SOMEONE has learned SOMETHING on the Ambulance in the past Week!!!!!

well - its not in the past week, but I learned that if a psycho gets kicked off the greyhound at the local bus stop, and the cops get called to deal with them, the cops with somehow ALWAYS manage to convince them that they have some kind of medical problem, so they can call the EMS to haul them.

Officer - "Oh gee, I was SURE she said she was having chest pain. That's odd that she says she's not having any now."

Sorry for the bump, but:

Heres one from my ride along (I'm about 3/4th of the way through my EMT-B class).

If you are dispatched to a Bike vs Car with a ridealong, then the bike will win and the patient will sign out AMA.

If you are a police office at said accident, then it is not a good idea to badger the EMT that is TRANSLATING for you to the pt. that doesn't speak English about whether or not the pt is going to file a police report every 5 seconds in a not so nice voice.

This action will result in the EMTs (EMT-Ps from the engine to be specific) getting the AMA signed in record time which will result in you losing your translator. The traslator will also kindly inform the patient that and question involving the word "report" deserves a "No, I just want to go home" answer.

I don't see how CO2 and sodium hypochlorite can react that badly? CO2 is already in its oxidative state, and sodium hypochlorite is an oxidizing agent. Maybe there were other unknowns chemicals (such as NH3) inside the vehicle that reacted to the bleach. Or maybe the concentration was a little too strong, and the vehicle wasn't properly ventilated, since the fumes from bleach is pretty powerful

sorry for the tangent - gotta defend chem majors :)

Maybe it was an ammonium phosphate dry-chemical extinguisher.

This is the best thread I have read for a long time! I have been doing this for a few days and have to say, it is all true....

Another bad thing to do....

DISP nursing home for CP. Arrive to find 4 people in the room, all stating they have chest pain. Only one had it since this morning. The staff, as suaual have no idea about her, "The RN is getting everything together, she is normally really healthy", thanks.

Go though the questions, pt reports no allergies/history/some unk meds, monitor, line, drugs.

Start to leave and the RN come up and said "You know she is allergic to NTG"

As normal, the reaction the pt has is a HA and lower BP.

The appropriate statement to the pt is not "We are going to take you out of here before the nurses can do anyhhting else to try to kill you."
:meanie:

Wow. Don't they know it's not even POSSIBLE to be allergic to nitro?

Sorry man, I just take issue with this post. Some of the things you said were a little funny. BUT, you dont sound like the type that should be criticizing any other health care professionals.

No person should criticize any health care profession, regardless of their credentials or competence. Period.


I bet most people getting off that boat from the Carribbean can spell PIECE, CARRIBBEAN, not to mention STETHOSCOPE.

I just love it when people correct the spelling of other people with their own incorrect spelling. It's spelled caribbean.

More as a hint to patients...

If you call us saying you have a migraine, yet have the audacity to have 10 dresses on a hanger and 2 suitcases packed when we arrive, we will NOT take you to a 'bandaid' station hospital 1.5 hours away as opposed to one of the 2 nearest hospitals < 15 mins away.


As a corollary, we won't do it the second time you call (1 hr later) either.


:) This isn't much of a bump, but this thread needs life!

More as a hint to patients...

If you call us saying you have a migraine, yet have the audacity to have 10 dresses on a hanger and 2 suitcases packed when we arrive, we will NOT take you to a 'bandaid' station hospital 1.5 hours away as opposed to one of the 2 nearest hospitals < 15 mins away.


As a corollary, we won't do it the second time you call (1 hr later) either.


:) This isn't much of a bump, but this thread needs life!

esp when the second call is from the ED payphone. fuking system leeches!

esp when the second call is from the ED payphone. fuking system leeches!

You've had these patients too then :) I never believed it to be true, until they hopped onto my rig.

along the same lines I have seen people call 911 from the er waiting room stating they have a medical emergency and aren't being seen fast enough and want a ride to hospital x instead.....
as a medic in a busy system I have called for orders from the hospitals ambulance bay.....
"we have xyz and need orders for bretylium...what is our eta? zero...we have been here for 5 minutes and you haven't found us a space for the pt yet. yes I know you are on divert, everyone is on divert, so guess what , this is your pt....."

If I'm stripping paint off the floor, open a window.

This man was found by wife after an entire day of work in the basement with no ventilation. This person probably had the most chemically damaged brain I have ever seen. He never said a word, was a little combative and was slowly looking around the whole time in the ambulance.

along the same lines I have seen people call 911 from the er waiting room stating they have a medical emergency and aren't being seen fast enough and want a ride to hospital x instead.....
as a medic in a busy system I have called for orders from the hospitals ambulance bay.....
"we have xyz and need orders for bretylium...what is our eta? zero...we have been here for 5 minutes and you haven't found us a space for the pt yet. yes I know you are on divert, everyone is on divert, so guess what , this is your pt....."

The hospitals abuse the courtisies that EMS provides by holding the patient in Triage. We started a 20 min policy due to simple liability. Have a bed in 20 min or the patient goes on the floor. They hate us! It's sad how lawyers have killed patient care and compassion.

1. Patients die with or without you and in spite of expert paramedic assistance.

2. Elvis has indeed left the building when the patient sucking on a nebulizer simply dangles it from the corner of an open, drooling mouth.

3. Please check the patient prior to pressing the, "silence alarm" button when the sp02 probe reads 80% AND correlates with a reasonable heart rate.

4. Yelling at patients who speak a foreign language doesn't make them understand you better.

5. Securing obese patients to a stretcher will make it harder for them to be ejected from your cot once it buckles under the force of gravity.

6. Projectile emesis into a NRB set to "flush" makes for interesting facepaint.

7. Circle of death: An entire truck company rendering assistance to a critically ill patient.

8. When you're behind the eight ball and patients are actively trying to die, remember that it is not YOUR emergency. Also remember that asystole is much easier to remedy than hypotensive cardiogenic shock.. unless you're emedpa. :)

9. Aggressive masturbation is a proximate cause of flash pulmonary edema in the aged, infirm, and bed-ridden nursing home patients.

10. Sending paramedics to fire school does not cause them to appreciate engine companies even more. As a matter of fact, paramedics who complete fire college are 10x more likely to suffer from chili stirrer's elbow, recliner tendonitis, play-station thumb, and sacral pressure sores.

Why go through the trouble of selecting an obstetrician when a mobile field delivery unit is available 24/7? You'll never wait for your next appointment! God keep us poor EMS workers,


-Push

Since there has been a lot on NTG...
When you take three (yes, 3) doses of NTG all at once for your dizziness then call 911 via your "life alert," don't becomes angry because we cannot get into your house because you are laying prone in front of the locked door and every time you reach up to unlock it you nearly have a syncopal episode. When we finally do get into your house please do not try to convince me that your physician told you to take your NTG when you became dizzy. Then don't go on to tell me that the same physician told you to take all three doses at once. Also, don't become demanding when we are not able to mystically fix your dizziness in an instant, "just like on TV."

more NTG goodness,
Don't walk over to your neighbors house when you have chest pain and don't let that neighbor put one of his NTG patches on you. When you do begin to feel better don't go for a walk into the forest, collapse, and have your family expect you to survive when you have managed to get two miles back in undrivable terrain.

Do make sure that the little spray nozzle on that NTG spray is pointed at the Pt's mouth and not your face, arm, hand, eyes, partner, ect...

Don't play around with the NTG spray and say, "look its empty!" as you spray it into your mouth (not me I swear) The rest of the EMS crew on that day will laugh at you.

Do call 911 for Pt's that need us, instead of driving, calling a taxi, taking a bus, ect.

Don't call us for Pt's that don't need us.

Don't be surprised when the paramedic/emt admits to not having a magic wand, or that the magic wand batteries are dead

Don't seem surprised when the EMS crew does not appreciate it when you call them ambulance drivers.

if you are a BLS fire crew and you are on scene with my partner and me (the last ALS crew in the valley. It was a busy day) for the old guy can't pee for 2 days call. Please don't leave when the 2 year old drowning victim one block down the street call comes. Then transport the 2 year old in the back of a PD vehicle while trying to do BLS CPR while passing us (the ALS crew) while we load the can't pee guy into our rig because we can't leave now that you left. Then please don't have your chief call and complain because there were not enough ambulances. We were not the ones that left us on scene.

and

It is okay to cry...

Always wear clean underwear...

If you going to shoot yourself in the face, don't miss. Anything worth doing should be done right...

If you're going to drive around naked with some girl that isn't your significant other who may or may not have her boobs taped down (WTF?), don't do it drunk...

If the same significant other pisses you off one night, don't reach in the sink and throw the first utensil you grab; it will invariably be something long and sharp...

Don't let the foley bag get covered with a sheet. They will open if you step on 'em and I guarantee you'll be going down a hill when it does...

Don't eat the biggest meal of your young life and then drink yourself 3 times the limit...

If the lady at the front desk of the nursing home laughs and says I think they might be doing CPR, when you were dispatched nonemergency, she doesn't have a f'n clue and they are indeed thumpin' away down hall 2...

We get a call for a 77 y/o female with chest pain. Upon getting there we see said female in bed on top of towels which were placed there to absorb all the sweat. This patient had all the classic signs of AMI. Chest pain with referral to left shoulder, nausea, sweating profusely. BP 80/40, first 12 lead showed ST elevation in V1-V3 and depression in II, III, and aVf. We advised the patient to go to a hospital with cardiac cath capability. The response was....NO.. I want to go somewhere else. Furthermore all we can do is give her ASA, which she REALLY doesn't want to take because of her GERD. We bring her to that somewhere else. On the way we repeat the 12 lead...elevation now V1-V4 and more pronounced depression in I, II, III and aVf. Still, the patient doesnt want to go somewhere else. Finally, we get to the hospital and immediately the ED attending calls the hospital where we wanted to bring her to arrange a transport. We go to that hospital later that day and find out that the patient coded in the ambulance bay and barely made it to the cath lab. Moral of the story....listen to the EMT's (we know what we're doing).



Damn that adrenaline rush...gotta love EMS :D

At least with Trauma regulations you can make a patient go to a trauma center. I am all for patient autonomy, but sometimes I think there should be CVA and AMI regs as well. It is not like the old days when every hospital did the same thing. Many patients, esp the older ones don't realize that.

Could you have tried calling med control at the hospital she wanted to go to.... maybe they would have redirected you based on her presentation?

Frustrating call!

We get a call for a 77 y/o female with chest pain. Upon getting there we see said female in bed on top of towels which were placed there to absorb all the sweat. This patient had all the classic signs of AMI. Chest pain with referral to left shoulder, nausea, sweating profusely. BP 80/40, first 12 lead showed ST elevation in V1-V3 and depression in II, III, and aVf. We advised the patient to go to a hospital with cardiac cath capability. The response was....NO.. I want to go somewhere else. Furthermore all we can do is give her ASA, which she REALLY doesn't want to take because of her GERD. We bring her to that somewhere else. On the way we repeat the 12 lead...elevation now V1-V4 and more pronounced depression in I, II, III and aVf. Still, the patient doesnt want to go somewhere else. Finally, we get to the hospital and immediately the ED attending calls the hospital where we wanted to bring her to arrange a transport. We go to that hospital later that day and find out that the patient coded in the ambulance bay and barely made it to the cath lab. Moral of the story....listen to the EMT's (we know what we're doing).

Your post brings up some very interesting points. First of all, please don't see my reply as a critique. I've been in very similar situations and it is unfortunate that EMT's are placed in the often precarious position of patient advocate.

Remember that a competent patient, despite harrowingly unstable vital signs, has the right to refuse treatment AND determine their own destination. I can think of no emergency physician, especially considering today's EMTALA laws, that would willingly refuse such a patient. The 'refusing' physician would have to take responsibility for your patient during transport to a definitive care facility. From your post, it seems that your patient was aware of the risks in transport to whichever hospital. The patient, therefore, is responsible for the consequences despite whatever lawsuit she may try to arrange. Wouldn't it have sucked if you'd have saved her life, transported her to a cath-capable hospital, and then you were slapped with a false-imprisonment lawsuit? LOL! As health care providers, we can only suggest the best course of action to our competent patients. It is up to them to carefully consider the risks and benefits of any resulting choices. The only exceptions are for minors, individuals in policy custody (Baker act), or individuals under the influence (Marchman)... etc..

The good news is that current guidelines and studies (recent issue of Annals/AHA ECC guidelines 2004) support paramedic directed triage. Since the door to drug and door to balloon times are increasingly unforgiving, it is imperative for people to be routed to appropriate facilities. Ideally, transport protocols for AMI, stroke, and trauma patients will one day exist side by side. EMTs, as you say, DO KNOW what they're doing.. but their decisions must be supported by corresponding legislative and medical authority. Perhaps you could talk the case over with your medical director. I doubt that s/he will REQUIRE that you MUST bring a particular patient to a specific facility.

Finally, there exist other options for the treatment of hypotensive cardiac patients. You mentioned that you could only give ASA? GERD is in no way a contraindication for class I aspirin therapy. Furthermore, it sounds like the massive anterior wall MI was causing some fairly severe systolic dysfunction / backup. Sometimes, these hypotensive MI patients benefit from judicious (100-150 mL) fluid boluses in order to increase cardiac output. With such crappy pressures, the vicious cycle of ischemia/infarction/failure/catecholamine release can only devolve into cardiac collapse.

Great case.

If I decide to kill myself I will not try

....mixing ant poison and beer

....drinking liquid potpourii

....to chop my own hands off with a knife

.... to set myself on fire

..... to hang myself over a door the same height that I am including the length of the rope

.....to take ibuprofen, aceteminophen or any other over the counter medicine.

....by taking a handful of antibiotics


....or laxatives




:eek: :eek: :eek:


GOOD LORD!!!!!!!!!!!!!!! :eek: :scared: :rolleyes:

hell if it werent for stupid ppl, we'd be out of business..... :rolleyes:

Speaking of NRB masks... kind of a random question I've always wondered:

On airplanes they always give the "if cabin pressure should drop oxygen masks will fall" speech before the flight. The flight attendant always says that the reservoir bags will not inflate but that oxygen is flowing. So these bags must serve some other purpose than in NRB masks. Does anybody know what function the airplane mask reservoir serves?

Something to do with containing the oxygen in case of fire?? (seems far fetched but its all I can think of)


I have a pilot friend of whom I asked a similar question-

Me: So, why the masks and no reservior inflation?
Him: Haha they're simply to muffle the screams.


Morbid, but probably true. The great thing about plane crashes- the great equalizer- everyone goes!

I have a pilot friend of whom I asked a similar question-

Me: So, why the masks and no reservior inflation?
Him: Haha they're simply to muffle the screams.


Morbid, but probably true. The great thing about plane crashes- the great equalizer- everyone goes!
Oh now that's classic! I'll have to remember that.

The bags were put on there to give the impression of something working- but only later did they realize that they don't always inflate. At least this is what was told to me by an aviation mechanic friend of mine who works on Boeing 767 and 777 life support systems for a major airline.

This was asked before, I dug up an answer that 'seems' resonable:
http://forums.drslounge.com/showthread.php?t=109585&page=2&pp=25

I'm not an expert on airplanes or oxygen use by any means, but I ..*cough* borrowed *cough* this from an out of date pan american flight instructors guide for a DC-10...

....

l5. Q. What is the function and purpose of the rebreather bag?

A. The first part of the exhalation is rich in oxygen and

thus is suitable for rebreathing and it passes down

into the bag where it mixes with the incoming oxygen.

The bag then becomes extended and the slight pressure

thus formed causes the remaining portion of the

exhalation, which is high in carbon dioxide content,

to pass out through the sponge rubber discs. The

advantages of the rebreather bag are as follows:

(a) Rebreathing the oxygen rich portion of each

exhalation greatly increases the effective use

of the oxygen available.

(b) The carbon dioxide conserved by the bag

stimulates breathing.

(c) The humidity conserved by the bag prevents

dryness and soreness of the throat.

....

EMT-Bs working interfacility transports have the inability to please anyone.

Dispatched for an ER call w/ a CC of "unstable chest pain" from a SNF. This place is litterally just down a side street from the nearest hospital. There isn't even a traffic light between us and the hospital. Pt. A/Ox1, unable to point or really communicate efficiently with us. Nurse reports left chest pain radiating to the arm w/ a BP of 180/something x 4 hours. We get about the same BP. (Please don't ask why the SNF didn't call 911). We load the Pt up (we being my partner, the trainee, and me) started on 15 LPM via NRB and transport down the street to the hospital. Travel time is less then 2 minutes.

The welcoming party:

1 extremely pissed off RN complaining that we should have called medics and giving us the tired old line, "What drugs would you have pushed if the Pt. had crashed in route"

Of course, if we called medics, the medics would have complained about how we should have transported.

Of course, if we called medics, the medics would have complained about how we should have transported.

It's a situation that all of us have been in. You would get criticism either way. It's so easy to criticize others when in fact you weren't in their shoes.

This is something I keep in mind everytime I receive a patient from an EMT, paramedic, or even receive a nurse report.

Yes, calling a medic would be ideal, but as you pointed out it probably would have delayed definitive care.

Yes, calling a medic would be ideal, but as you pointed out it probably would have delayed definitive care.
Aye, we end up transporting quite a few really bad medical patients from [un]SNFs over time. My areas transport guidelines are "Any patient may be transported via BLS to the nearest PRC if the time to estimated paramedic arrival and evaluation exceeds transport time to the PRC." (http://www.ochealthinfo.com/docs/emstreatguide/i40.pdf).

Sometimes I actually get to feel more then a gurney van attendent.

I think we have all been in this exact situation, and it is a judgement call. I personally always chose to call a 911 rig in, even though it would delay care (slightly) for medicolegal reasons. By doing this, I also helped "educate" the facility that dialing for a routine transfer rig was not going to let them sneak a patient out without the big fire truck being parked out front when the new customers were on tour.

...not going to let them sneak a patient out without the big fire truck being parked out front when the new customers were on tour.

I actually got written up for doing this because there just happened to be new customers on tour. The Pt was really gorked too, no palpable B/P, cyanotic, altered (duh), I mean really bad. It was totally appropriate to call 911. Needles to say I left that company.

If the patient comes up to the drivers window of the ambulance and states they've just been stabbed. Believe them. (I live in a low major violence area).

Pulled into Tim Hortons parking lot so my partner could get a coffee, saw the huge line up inside (bars just let out) so decided not to get one. Was turning around in the parking lot, about to start backing up when a guy run up to the drivers side window. Rolled window down, conversation went like this.
Him: "I've been stabbed" (wide eyes, big pupils) as he lifts up his shirt.
Me: "Really?" as i'm looking at the laceration with abdominal contents evicerated (however you spell it) thinking...him that looks real.

---I thought it was a prank. We get people coming up to ask us for stupid things (bandaids, cold packs) or staying stupid things...I fell last week, should I go in..I was once in an ambulance...Can I go for a ride...Soooo thought this was along the same thing...nope.

Called dispatch asked for police, locked all the doors (assailant was no where to be seen) got into back with the patient. In the time span of 5-10 minutes (scene and transport) patient turned crappy, pale, diaphoretic, clammy, BP dropping...

Anyways. Moral is...Don't become so cynical that you don't believe what people tell you (Especially when the proof is right in front of you!)

in philadelphia folks used to wave us down all the time with stupid questions....my favorite:
"dude, how long for valium to not show up in my piss?"
my answer " 2 hrs"
bet he got a big surprise later that day......

in philadelphia folks used to wave us down all the time with stupid questions....my favorite:
"dude, how long for valium to not show up in my piss?"
my answer " 2 hrs"
bet he got a big surprise later that day......

That is Hilarious :D

I have learned to never ever ever pig out at Taco Bell on gorditas, tacos and nachos untill you are ready to burst and then to a Txp to a level 1 with an unstable Pt that requires you to stand and lean over alot while going down a very very bumpy and curvy road. Not to mention the Pt is puking his guts out all over the back of your tiny little van style rig... Took every thing inside of me not to yack all over the place myself.. From what my partner said I was as green as grass when he opened the back doors. I will never again be able to eat taco bell without remembering that night... hahahaha
Lisa

a former partner of mine used to sit on the jump seat and take a crap in a bed pan during long transports rather than pull over somewhere with pts who were completely out of it(intubated icu types, gomer runs, etc). this was all well and good until one of them woke up to look straight up his crack mid-bm....he didn't lose his job but only because he was in really tight with the management(one of the senior managers was his uncle)

Shift change at nursing homes always occurs about 5 minutes before I arrive. As a result, none of the staff knows anything about the patient.

EXCEPTION:

Apparently sometime before 9pm, all of the nursing staff leaves except 1 nurse. Said nurse not only knows anything about the patient, but instead of admitting it, claims that it is all in the paperwork and doesn't have time to give the paramedics report because she "has to take care of the rest of the patients, and thus can not spend time helping out this one patient."

OMG.... If my partner ever decided to take a BM in a bed pan while I was in the rig with him I would have so pulled over opened the back doors on him nice and wide while facing oncomming traffic...
Lisa

We once had 911, people we are friends with, call our EMS headquarters to tell us that someone had been shot at our back door... "Hahaha...yeah right....click". They called back again, "Really, check your back door." Sure enough, there was a guy lying on the ground bleeding from a few gunshot wounds. Later we even found pock marks on the wall from the few that missed him. Luckily they built us a new station in a better neighborhood a few years later. But, not before people walked in with guns ("I just shot a guy..."), stole our cars, and smoked crack in our restroom...

My first intubation in the field was a drunk homeless guy in cardiac arrest. His last oral intake was Long John Silvers fish and Jim Bean Whiskey... Not a good combination :barf:

A paramedic with sleep apnea is not an indication to use the onboard CPAP... it tend to drain the main O2 rather quickly... :D Not that I would know...

I am finishing up my first semester of med school and I am missing EMS but this is some of the things I learned in 12+ years of Fire/EMS (all different types of job environments, and I live w/ a FF so I can pick on them:)

1) There is such a thing called the lug nut theory: The vehicle with the most lug nuts wins.
2)Why paramedics don't drive engines. (not me) but someone in dept forgot to put parking brake on, truck rolled out bay, and down driveway, a car actually hit it (thats called job security for the person just couldnt understand why the truck was moving but she decided to still not stop and hit the truck)
3)DONT take off shoes of homeless person to do basic pedal pulse assessment, no amount of vicks or wrapping the foot in sheets will help
4) The more important your appointment ( or big physics final) after work, the later and more of an ALS critical patient you will have closer to your off time...
5) Going by ambulance DOES NOT guarentee you being seen faster in fact, more cars in driveway, the quicker you go to triage.
6) Remember if you can't stand the site of your own blood, then don't practice IV sticks on yourself and ask me to take it out quick (yup actually happened, my partner and I laughed while my supervisor turned very white)
7) Don't turn the patient towards the wall because they are projectile vomiting, although thought is nice, the splash effect is way worse ( also in ER dont give them the smallest kidney shaped container the splash effect in those are great too)
8)Remember to do your walk arounds on MVA in car vs pole, the bullet holes on the opposite side might explain all the blood coming out the back of head....
9) What the heck is a pre-code? The above pt was a trauma alert, but the FD LT called a pre-code instead ..
10) dont forget to call clear even when using LP 12, hands free, (yup know someone who didnt and shocked a FF needless to say she wasnt highly thought of by that crew for a while)
11) No matter how many times you tell the ER staff you were having the attack of niceness and decided to help bring the pt in from the car outside you are still suppose to have mental telapathy (sp?) and know automatically everything about the pt.
12) The "welcoming committee" (whether large complex, big church school etc) the more people waving to you and telling you where to go the more BLS the pt, the converse is true to the more critical you're lucky to find someone who knows whats going on
13) Yes you can give morphine to the 80+ y/o F w/ hip pain s/p surgery from while ago and not healed right even though they are allergic to sulfa....
14) do not ask in spanish: donde est delore (sp? or in my very white spanish where is the pain) they will start answering you very fast, instead ask pain here (in spanish) can get yes/no..
15) Remember no matter what and no matter who you are BLS before ALS...


I think this thread is great, laughed very hard reading earlier posts about Fire extinguisher and bleach....I am sure will think of more later..

Cocaine and bridges don't mix...

Last night we were dispatched to "Meet PD on a subject threatening to jump from a bridge." Upon arrival we were told the subject was being chased by the police and jumped from the bridge... getting to the pt added an additional 12 minutes to the scene time. Once at pt's side found that pt had jumped over a k-rail and fallen approx 150ft and landed feet first on gravel surface (railroad size gravel). Trauma alert given and emergent tx began. Pt delivered immobilized and IV etc... Unstable/Crepitus to pelvis, deformity/crepitus to right hip, 4 inch shortening and outward rotation to right leg, obvious fx to right wrist. ALOC (2nd to fall vs. cocaine, who knows... who cares... ALOC is the point) Total time with pt including scene and transport time 9 minutes 17 seconds. Upon arrival at "Trauma Center" find one nurse and empty house. RN sts this pt is level two and she told our dispatcher to send us to the level two hospital... Too bad... Pt is here and I gave trauma alert... Same sh*t, different shift from ED staff. Pt later codes and dies from massive internal bleeding...

Things we learned or are reminded of:

1.) Cocaine and Bridges don't mix.
2.) 150+ft fall is a level one trauma in OK, TN, CA, Europe... anywhere...
3.) RN's still cannot and should not triage EMS pt's over a phone... that is the job of the EMS personel onscene with the pt.
4.) Some "Trauma Centers" still don't want EMS to bring them trauma pt's.

Some call me bitter... don't know why... I love my job :meanie:

On a lighter note... The pt was being chased by a police K-9. The pooch went over the wall and fell with the pt. K-9 dazed and ambulatory after fall collapsed in field next to roadway. PD helicopter lands next to K-9 and airlifts dog to Emergency Vet Clinic... K-9 is sore and bruised but will be just fine... I think Rin Tin Tin deserves a metal of valor...

It wasn't the fall that killed him...it was the dog landing on him. :meanie:

I'm always amazed at how many people don't know how to use their inhaler, thank God for nebulizers.

I'm always amazed at how many people don't know how to use their inhaler, thank God for nebulizers.
That's the fault of physicians and nurses. It's our responsibility to teach them how to use the MDI's. When I write a script for an MDI, I always teach the patient myself. I make them demonstrate how to use it.

It annoys me how nurses do not obtain proper PEFR's using Wright flowmeters. This annoys me more than patients who do not know how to use their MDI's. I hate it when a nurse tells me that a patient's peak flow is 150. I walk into the patient's room, instruct them how to use the flowmeter correctly, and end up with 350-400. That's discharge material as opposed to an ICU admission!

Actually be annoyed at respiratory therapists....that's their job :laugh:

Actually be annoyed at respiratory therapists....that's their job :laugh:
Peak flows are measured by the nurses. Respiratory therapy only comes to the ED for ventilatory management, continuous nebs, BiPAP/CPAP, and Heliox. RT's also do bedside PFT's (limited) for things such as Guillian-Barre Syndrome.

Routine nebulizers, peak flows, etc. are done by the nurses.

You know what really grinds my gears? :laugh:

People that don't know that their NTG is for.

The reasons I've heard, they usually start with, "my doctor told me to take this when"

My face gets flushed
I can't catch my breath
I get dizzy
when my belly hurts
I get dizzy and,
I feel anxiety
I get dizzy (did I repeat that one enough)
I feel numbness and tingling
I get a headache
when my back hurts...

It goes on and on..

And about not knowing how to use an MDI. I've used an MDI on and off since I was a kid. I never learned how to use is correctly until EMT class some odd years ago. Sometimes I am amazed at the ignorance of patients. I guess blame can be placed on providers for not educating Pt's but how much can you chock up to Pt's not caring or paying attention. I find it hard to believe that 70% of all the Pt's that I come across that take NTG were never educated on its uses and indications. Because of that I do lay some blame on Pt's.

Things I learned a long time ago working some EMS in a country far away from here:

#1 If you weigh 90lbs and your resting BP is 80 over nothing, you shouldn't take your friends NTG gel-cap just because she was told to take that if she doesn't feel right (LoL found pressureless and unconscious during sunday mass in a rural church at the far end of the county, 3-4 half-lives later she was back to her sweet self)

#2 Don't try to stop your 2ton truck by leaning with your back against the front bumper while your 4 year old inside is driving. Yes, he is only 4, but the truck is in 1st gear and a diesel (young guy with dung laced tire-treads on his chest and face on a sheep meadow at the very far end of the county).

as part of #2
#2a 110mph on a farm to market road might allow you to beat the chopper to the scene, but if you don't get to the scene you won't help the patient.

haha I got a good one today:

If you are a hobo and you decide to try and hang yourself in public, please do remember the following:

-Your shoe laces will not work
-Tie yourself to a part of the tree that will hold your weight
-Do not fake a seizure when you land on the ground
-Remember to empty your pockets of or at least make use of any and all remaining crack rocks on your person
-When questioned by the police as to why you did this, do not under any circumstances cite the following reasons:
"Gas prices"
"I was entertaining the crowd"
"I mixed coffee and tea today"



The ED triage nurse couldnt help herself from laughing after hearing the story-- one of those laugh out loud, and then shake your head in disgust and (hopefully) a little empathy kinda situations. The guy was high as a kite, said he did "2 bags" of heroin x 2 hrs ago but he was talking a mile a minute with his eyes darting all over the place... "yeeeahh... so what ELSE did you have today, sir?"


EDIT: on a semi-related note, just out of curiosity does anyone know how much a "bag" of heroin actually is, and what the street value is for it? I always hear heroin amounts discussed in # of bags, are all bags in this case generally the same size or what?

EDIT: on a semi-related note, just out of curiosity does anyone know how much a "bag" of heroin actually is, and what the street value is for it? I always hear heroin amounts discussed in # of bags, are all bags in this case generally the same size or what?

I believe it's 15 g by weight, but only 25 mg of heroin. Some dealers put up to 100 mg of heroin in a bag, which is where you find your overdoses. Addicts usually don't overdose on purpose -- they generally only want to get high, not kill themselves. So usually they are unaware of a stronger than expected concentration when they overdose.

Street value is about $10-40, depending where you are, dealer, and concentration.

I believe it's 15 g by weight, but only 25 mg of heroin. Some dealers put up to 100 mg of heroin in a bag, which is where you find your overdoses. Addicts usually don't overdose on purpose -- they generally only want to get high, not kill themselves. So usually they are unaware of a stronger than expected concentration when they overdose.

Street value is about $10-40, depending where you are, dealer, and concentration.

Did you by chance learn this on call?

Did you by chance learn this on call?
No, I'm a toxicology freak.

Never eat a bowl of soup while driving, ever...

No, I'm a toxicology freak.

Freak is right.... ;) j/k

I really do...makes some of the things I've seen look not quite so bad...

Some of the things I've learned....(actually....I knew...seems to be common sense isn't so common though....I've seen some incredible things)

When your pt codes...in a w/c....remove them from the chair before begining compressions....they seem to be more effective that way (I love SNFs)
When your pt yells "OUCH" with every compression it's ok to stop....(This one didn't want to even with medics telling her that they would take pt care....yes again @ a SNF)
On the scene of a MVA (w/multiple pts)...if your brand spanking new extremely green over ambitious adreniline pumped EMT hunts down the head and places it back on the victim who has been decapitated.....leave them be....Can they really hurt this pt by performing CPR?
Motorcycle Vs Overpass.....he ran into the pole- 100mph+.....There will be lots of his friends around...they *will* freak when you start cutting the leathers off...and if you can't open the face mask on the helmet....put him in a controlled area (ie..your rig w/doors shut and someone large at the doors) before attempting to figure out if it might be because the helmet is now backwards. (It was....only injury was that his head was now facing the wrong way.)
And one more CPR....Can anyone explain securing an airway and performing compressions when your pt is strapped to a backboard.....Facedown?
When you get a SOB pt who was breathing at 40+/min (per staff) but "She's much better now. Since we gave her some O2, her resp rate decreased dramatically"---First the O2 will be 2L (maybe even 4L) by NC (of course on the bridge of the nose/under the chin/laying next to the pt....) and the resp rate has slowed because it is now agonal.
When the ambulatory A&Ox4 pt refuses to go to the ER due to a uncontrollable nosebleed - (bp 102/58 - p 114) - because she insists that if the SNF staff will just give her her AM meds....esp the one for HIGH BP....the nosebleed will stop. Wait close by because as you leave the staff will give her the meds....and she won't be A&O when you come back. (You do get to transport with the pretty lights on though.........I think I spend too much time at SNFs)
When the full arrest was witnessed...they usually don't have rigor or lividity. I guess I could have asked *when* the person coded.
And sidenotes..............(AKA things I would love to say to LPNs.....)
If you (or your pt) missed your MD appt (f/u of course) do not call me to transport you to the ER so you can see your doc...chances are he won't come there. Esp btwn midnight and 6am
When you wake a person up 2 hrs after giving them a sleeping pill.....they are going to be a bit altered.....and maybe even almost impossible to wake.
Don't call me for a pt w/ AMS because the pt isn't responding to your questions when the real problem is you pissed off your pt and they have decided not to speak to you.
Before you call me for a pt w/ elevated temp & no response to APAP....take off the 8 (yes 8) blankets that are on her and see if that helps a bit. (Oh ya might turn the heat down some....it's only 85 out.)
If you call me at 3pm shift-change SAT because your pt fell MON and has a tib/fib confirmed by xray TUES (Obvious btw....) Don't call and complain because I upset your visitors by leaving *hot* to take this pt to the trauma center 20 miles away because there is no distal pulse now (no splinting and pt picks up her leg to show you how it dangles!!! Closest center as well)
And ...........No matter what color your pt is initially...........unless they are a Smurf........Blue is Bad - this is esp true when combined with RR <8 and no/barely palpable carotid pulse. Do not wait 20-30 min for private EMS...Call 911.
And last but not least......You called me...I came (this call had a 3 min response/on scene time)....pt is altered...My partner has made contact.....Do not expect me to be all smiles and nice when you tell me they are going to the hospital you just haven't decided how....as you "may need to call 911". Just because I currently work in private EMS does not negate my patch. I carry the same equip, the same drugs and have the same skills. You are now causing a delay in pt care. (And don't expect me to hang out and wait while you do the d-stick on your known diabetic to see if that is the cause of the AMS!)

Actually..........I know that seems like nursebashing.....I've run across some absolutely fab nurses...in all areas...who love what they do and it shows. I've also run across some who obviously don't give a rat's @$$ about anything but the paycheck.
And give me a good basic over a bad medic anyday...........90% of what we do is basic stuff anyways. The bad medics skip that and seem to forget how to do simple things.

Freebyrdy

For those partners the drive like they are in a little sports car......
1000cc NS works well.....Make sure you are on a straight away before you smack them upside the head with it.
Towel rolls are good as well. (Same priciple as above)
You can also use pedi/infant BP cuffs (preferably in their cases), stuffed animals and other small objects - well aimed they get the point across.
Worse comes to worse.....Suggest they try to catch some zzzz's while you are out "posting". Then you get to drive around and see how many times you can make their head bounce off the window or if they lay in back....bounce off the bench/stretcher.
Freebyrdy

Also, would someone please alert the Nursing Staff at nursing homes that:


If your patient is Cold, CLammy, unresponsive, and has AGONAL breathing, IT IS NOT SUPPORTIVE OF LIFE...

and...

Proper treatment is **NOT** 2L O2 ON NASAL CANULA!!!


This is unfortunate but true... Nursing home nurses are not allowed to do any medical treatment other than standing orders, i.e.- place the pt on any form of O2, or give oral glucose, or glucagon for that matter without the Doctors permission. sad but true. unfortunately again this still gives no excuse for those nurses that do place a pt on 3lpm on a Non-Rebreather. Remember: these nurses are the ones that have been scraped off of the bottom of the nuses pool. :cool:

I'm surprised this was never stickyed :)

Another thing I learned early on as a medic is:
if you are thinking about intubating a patient you probably should be.

Doctor+pulse oximeter+nursing home friday afternoon shift= abuse of the 911 system.


Though it was posted over 2 years ago, it remains as true today as ever!

Whoever thought it would be a good idea to allow nursing home staff access to oximeters should be beaten with them.
Doctors who diagnose over the phone based on one piece of information (the SpO2) are next on the list.

I know nurses aren't allowed to do alot, and thats a reason I don't want to be one, but the MD doesn't have to order common sense.

I know nurses aren't allowed to do alot, and thats a reason I don't want to be one, but the MD doesn't have to order common sense.
Don't say that on your interview about nurses, man!

Sounds heartless, but I keep joking to my fellow employees that we need to hand out pamphlets on how to correctly committ suicide. Like, don't OD on NSAIDS, you'll go into liver failure, seize and flop like a fish, and die of DIC.

Patients can in fact be allergic to benadryl.

If you are driving home from PT for your shoulder because you had surgery 6 weeks ago and you get into a low speed MVA (~15 mph), the pain you feel in your shoulder is most likely from the fact that you just went through PT, and not because of the accident.

If you call for a non-emergency patient and are told we can't get you an ambulance for another 1.5 hours (I work at a company that does both transports & EMS calls), don't be surprised that if you tell us your "not in distress chest pain patient" isn't an emergency, we still show up in 10 minutes anyways. And if you give a patient 3 nitro without a line, a) she's likely not going to be in any distress, b) will likely have a low BP, and c) will be complaining of a severe headache.

If your patient falls out of bed at 1 pm complaining of back and neck pain, when you call us at 6 pm to take the patient to the hospital, don't be surprised if they no longer have pain after you having given them tylenol 45 minutes ago.

If you are a 20 year old female EMT, chances are your male psych patients will not only find it attractive, but will decide to profess said love for you both on scene and again in the ambulance, complete with love songs.

Everybody complains about NRB on too low of a flow...but what about the concerned family members who up the nasal cannula flow to 10 LPM?

Confusion is normal for patients who have a history of Alzheimer's. Just because your grandmother has confused you with nearly every male member of her family thus far, don't be surprised when she starts referring to you as your brother, even if she's never done that before.

If you're planning on killing yourself, don't give a phone call to your best friend to tell them good-bye if you plan on OD-ing. Help will get there very quickly.

If you have a psych patient that walks past the nurses station and security desk, hitchhikes 15 miles into the next city and has been picked up by the cops and returned to your NH, don't call the ambulance for a "patient with psychiatric history to be transported to the nearest hospital" and conveniently forget to tell us of this escapade when we ask upon arrival. Because when we talk to the daughter who has no idea what's going on either, we will convince her its probably better to take him directly to the psych facility for evaluation, as opposed to being taken to the hospital, from where we assume he will be transferred to the psych facility eventually anyways (and being as we are the ones who will be doing the transferring, we'd like to save ourselves the extra trip). The psych facility won't be too happy about you bringing him in, and the NH staff gets annoyed that he never had a doctor check out his physical condition to make sure he didn't get hurt/sick while exploring the city.

Everybody complains about NRB on too low of a flow...but what about the concerned family members who up the nasal cannula flow to 10 LPM?


What about the RNs who tries to titrate NC flow up to 15 LPM and then tells you to take this patient now because he is very sick (and turning blue).


If you have a psych patient that walks past the nurses station and security desk, hitchhikes 15 miles into the next city and has been picked up by the cops and returned to your NH, don't call the ambulance for a "patient with psychiatric history to be transported to the nearest hospital" and conveniently forget to tell us of this escapade when we ask upon arrival. Because when we talk to the daughter who has no idea what's going on either, we will convince her its probably better to take him directly to the psych facility for evaluation, as opposed to being taken to the hospital, from where we assume he will be transferred to the psych facility eventually anyways (and being as we are the ones who will be doing the transferring, we'd like to save ourselves the extra trip). The psych facility won't be too happy about you bringing him in, and the NH staff gets annoyed that he never had a doctor check out his physical condition to make sure he didn't get hurt/sick while exploring the city.
Your SNFs normally gives you report?

What about the RNs who tries to titrate NC flow up to 15 LPM and then tells you to take this patient now because he is very sick (and turning blue).

Well....I saw a nurse who turned off the O2 to a patient who was basically agonal because she thought "O2 toxicity" was causing his problem. "He's a COPD'er after all!" *pulls hair*

Well....I saw a nurse who turned off the O2 to a patient who was basically agonal because she thought "O2 toxicity" was causing his problem. "He's a COPD'er after all!" *pulls hair*
Hahahaha............why is it that nurses think they're more educated than us when they demonstrate such a lack of understanding of topics such as COPD? I mean, there is obviously a huge gap between the best and worst nurses, but even the worst nurses try to impose some sort of superiority over paramedics.

Hahahaha............why is it that nurses think they're more educated than us when they demonstrate such a lack of understanding of topics such as COPD? I mean, there is obviously a huge gap between the best and worst nurses, but even the worst nurses try to impose some sort of superiority over paramedics.

How about the CHFer with exacerbated CHF that you can hear breathing from down the hallway, and the nurse yells at you when you start bagging them, because you don't have standing orders from the doctor to give them oxygen?

Your SNFs normally gives you report?

Not if they can help it. But being as most of the patients we deal with are completely out of it, we make them give us one anyways. Or at least try to.

I learnt today that Scabies generally starts between the fingers and work their way down.

(At SNF picking up patient with a CC of "fever"
Me: Anything else I need to know [before I see the patient]?
Nurse: Nope.
Partner: So there isn't anything you're not telling us about?
Nurse: No.
Partner: There isn't anything that the patient has that you wouldn't want to bring home to your kids?
Nurse: Nope

[uneventfull transport]
[at hospital ED]
RN: These bumps and sores on the legs looks like scabies :scared: :eek: :confused: :thumbdown

[partner, who is going on vacation on Wednesday, and I, who has finals on Wednesday, develops psychosomatic itching]

EMP while looking at the patient: There are too many bumps for there it to be scabies and there isn't anything between the fingers...

Bored police& pepper spray/mace taught me a valuble lesson- always carry Johnson's baby shampoo. A 10gtt set & a NC are required to neutralize the spray- whether you use it for perps is discretionary! I learned it 5 years ago when the local PD were visiting our station & one of them snuck his spray out & nailed his partner!

Where should I post some incredibly important info everybody needs to know about portable O2 cylinder gaskets?

People who try really hard to kill themselves and fail spectacularly become Born Again Christians.

We had a transport out of the local crisis facility to one of the hospitals that does inpatient admissions. The nurse's response to what was wrong with the patient was "Have you read the paper lately?" which was followed by her handing me a news paper clipping. Evidenly a guy put five propane tanks in the back seat of his car and turned them on with the windows shut, but since it wasn't killing him fast enough, decided to light a match. Said propane tanks shot ~100 feet in the air, his car turned into shrapnel, significant damage was done to the 5 cars near his, and pieces of metal/glass were found up to 1 mile away. The injuries to the patient? First degree burns to the back of the hands and his face, ONLY.

His current reaction? "I tried real hard to kill myself, but evidently somebody up there is on my side. There's a reason I'm still alive, and by-God I'm going to find it and make the best of it." And proceeded to regale me with stories of the goodness of the Lord for the remainder of the 30 minute transport.

"A&E staff dont take too kindly to me filling in a Patient report form for each personality of a schizophrenic!"

:sleep:
Since you've got all that extra energy, why dontcha come wash & decon my rig, eh? I can't write the one report without a hand cramp!

A paramedic friend of mine learned that whenever you get a call for a cardiac arrest at an ice skating rink, get the pt off the ice BEFORE you defib; or be prepared for multiple pts (bystanders, partner, self, etc)

REMEMBER: everything you do must be in the patient's best interest & have a demonstrable benefit. eg: Splint & sling a humerus fx. Ergo, sternum rubs are out; no benefit to the pt. However, your average BS GOMER playing at being all gorked out can NOT sue you for 1)D stick 2) 16ga AC NS TKO & my fave 3)The NPA. :love: I've yet to see someone remain "unconcious" when I thread that puppy! It's especially effective! :D

If I come to the ED to take you to the nut-hut at oh-weird-hundred please don’t ask me to stop at your car & unload your 17 kilos of pop, smokes, twinkies & sundry worthless crap you picked up at Kroger on the way to the ED. When my 5 foot tall pixie partner turns out to be more accommodating & sympathetic (she must have gotten more sleep) & asks me to do it with a smile, do NOT get all bent out of shape when my 6’2” 250# weary self growls there’s no way I’m putting bags of crap filled with roaches from your car in my bus. Don’t ask my partner either; now she’s serious too!

A paramedic friend of mine learned that whenever you get a call for a cardiac arrest at an ice skating rink, get the pt off the ice BEFORE you defib; or be prepared for multiple pts (bystanders, partner, self, etc)

Bovine scatology. First of all, the paddles/patches most often represent the path of least resistance which the electricity will follow. Ice (unlike water) has high resistence. Even if we leave that bit of physics aside, electricity is NOT like sarin gas. A (relatively) little whiff is NOT going to create "multiple pts (bystanders, partner, self, etc)". Having been in the unfortunate position of being grounded and in contact with a patient who was defibrillated, I can tell you that, while uncomfortable, the incident did not make me a patient, and that was direct contact.

Simply put, your "paramedic friend" was trying to impress you with a "war lie" that simply isn't true.

- H

REMEMBER: everything you do must be in the patient's best interest & have a demonstrable benefit. eg: Splint & sling a humerus fx. Ergo, sternum rubs are out; no benefit to the pt. However, your average BS GOMER playing at being all gorked out can NOT sue you for 1)D stick 2) 16ga AC NS TKO & my fave 3)The NPA. :love: I've yet to see someone remain "unconcious" when I thread that puppy! It's especially effective! :D

Establishing responsiveness to pain is an accepted part of an assessment provided that the patient does not already demonstrate a higher level of alertness. BTW what is an NPA?

- H

BTW what is an NPA?

Nasopharyngeal airway - the "nose hose".

Establishing responsiveness to pain is an accepted part of an assessment provided that the patient does not already demonstrate a higher level of alertness. BTW what is an NPA?

- H
Certainly. But how you establish is important; sternum rubs can cause pain & injury but provide no benefit... +pity+ seen it sued brother, trust me! If someone wants to go to court it can & has been successfully argued that a sternum rub is not beneficial- but no one can argue about securing an airway! Let MDs with deeper pockets & better insurance do stuff that's hard for Joe Dumbass Public to understand. :rolleyes:

Nasopharyngeal airway - the "nose hose".
AKA the "nasal trumpet". :cool:

5) Going by ambulance DOES NOT guarentee you being seen faster in fact, more cars in driveway, the quicker you go to triage.

:laugh: We call that "Positive Good year sign". When you get niside the only light comes from a 60" TV & nobody gets out of your way. Really pisses em off when I break out my 5w LED torches & shine as many eyes as possible. "Sorry, where's the patient? Don't bother with the lights, I've got my own."

No matter how good your intentions, speaking Spanish to Spanish speakers is a mistake unless the 1st phrase out of your mouth is “Talk to me like an idiot child” or “Speak slowly & use small words”. I have to laugh the way they rattle along while I understand one word in 10!

Certainly. But how you establish is important; sternum rubs can cause pain & injury but provide no benefit... +pity+ seen it sued brother, trust me! If someone wants to go to court it can & has been successfully argued that a sternum rub is not beneficial- but no one can argue about securing an airway! Let MDs with deeper pockets & better insurance do stuff that's hard for Joe Dumbass Public to understand. :rolleyes:

Well, I am an MD. And I have 10+ years as a EMS instructor, with more than 8 years on the streets as a firemedic and 1.5 years as a Municipal consultant specializing in EMS. I have testified in court regarding national practices in EMS and standards of EMS education and helped prepare congressional testimony on the same. A sternal rub IS valid. The likelihood of actual injury (as opposed to producing the noxious stimuli as called for) is almost zero. OTOH, there have been well documented cases of turbinate damage (even avulsions) from the NPA. Likewise, clavicle rubs / pressure have produced fractures. But the force needed to fracture a sternum (and produce a tortable injury) is significant. I teach (and will continue to teach) sternal rubs. Using an (albeit minimally) invasive airway where not otherwise indicated is far more legally risky IMNSHO.

- H

Well, I am an MD. And I have 10+ years as a EMS instructor, with more than 8 years on the streets as a firemedic and 1.5 years as a Municipal consultant specializing in EMS. I have testified in court regarding national practices in EMS and standards of EMS education and helped prepare congressional testimony on the same. A sternal rub IS valid. The likelihood of actual injury (as opposed to producing the noxious stimuli as called for) is almost zero. OTOH, there have been well documented cases of turbinate damage (even avulsions) from the NPA. Likewise, clavicle rubs / pressure have produced fractures. But the force needed to fracture a sternum (and produce a tortable injury) is significant. I teach (and will continue to teach) sternal rubs. Using an (albeit minimally) invasive airway where not otherwise indicated is far more legally risky IMNSHO.

- H
Point taken. I guess y'all had better lawyers... everybody being all sue-happy (aggregiously letitigious society we live in yay) is half the reason I quit running municipal & just do rural & private. After seeing a guy get hosed in court AGAIN because of a wreck in which his bus was struck by someone who dam near drove on the sidewalk to get past all the cars stopped for him... it just really sours one on the whole compassion & humanity thing.

Speaking of waking people up, we got called to a bar at about 4pm for a guy who was drunk and starting to strip. He talked to us for a bit, was definatly altered, keep speaking to people and about stuff that wasn't there. We get him on the bed and he passes out. No response to pain, no response when we put in an NPA. We take him in emergent, IV 02 monitor etc. We move him to the hospital bed, and I start helping the staff strip the patient. I pull down his pants and the patient sits up in bed wide awake, grabbing his pants. I turn to the doc and say "patient responsive to pants removal."

Wow....lots of lol things here to read. Not sure how I found my self on these boards, since I'm a nurse, but I'm here and reading.

I've read alot of posts on the stupid/funny/ weird things you all have seen from LTC and nursing homes and not sure what I want to say.
Yes....it happens, put please dont' think its like this everywhere. I've seen alot of the stuff you all have posted happen. Most of the times, I feel like a piece of crap when I need to send a pt out to the hospital and can't even put the appropriate O2 device on them because I can't find a feaking mask, etc.
Yes, nursing homes are the worst places to send a loved one, but just remember, they do serve a purpose. As a RN with my BSN and EMT training, I know that when I go to work, I make a difference.

My point in this post, instedad of getting nasty about the idiot nurses, have you ever gone over their heads and reported them to the administrators or department of aging for their neglegece etc. Ignoring the atrocities that you see just perpetuates the problems that do occur.
Where I am, we are very fortunate that we have an EMS service that will actually come in and educate the nurses on what they expect during a transport emergent or non. No they shouldn't have to do this, the nurses should have some bit of common sense, but it has made a whole heck of a difference.

Wow....lots of lol things here to read. Not sure how I found my self on these boards, since I'm a nurse, but I'm here and reading.

I've read alot of posts on the stupid/funny/ weird things you all have seen from LTC and nursing homes and not sure what I want to say.
Yes....it happens, put please dont' think its like this everywhere. I've seen alot of the stuff you all have posted happen. Most of the times, I feel like a piece of crap when I need to send a pt out to the hospital and can't even put the appropriate O2 device on them because I can't find a feaking mask, etc.
Yes, nursing homes are the worst places to send a loved one, but just remember, they do serve a purpose. As a RN with my BSN and EMT training, I know that when I go to work, I make a difference.

My point in this post, instedad of getting nasty about the idiot nurses, have you ever gone over their heads and reported them to the administrators or department of aging for their neglegece etc. Ignoring the atrocities that you see just perpetuates the problems that do occur.
Where I am, we are very fortunate that we have an EMS service that will actually come in and educate the nurses on what they expect during a transport emergent or non. No they shouldn't have to do this, the nurses should have some bit of common sense, but it has made a whole heck of a difference.


I understand that there are a lot of good nurses/nursing homes out there (I used to volunteer at a good one back in high school), but where I live right now that's not exactly the case. Two nursing homes have been shut down by DOH in the past 3 years for violations of all sorts of stuff, as well as inappropriate care. Two others are on "probation," and the reason the one at least hasn't been shut down yet is because they had such a hard time finding places for all the patients they had to take out of the most recently closed facility, and all the other nursing homes in the area are still overcrowded. There are also a few more in the area that have been on probabtion from Medicare for violations of their regulations.

I've reported nurses to the administrator (about the LPN to the one of very few RNs actually in the building), and as a result she called our office to complain that the crew was being "disrespectful" in front of the patient, when in fact my partner was taking care of the patient, and when the head nurse showed up to make sure we were treating the right one, I took her out into the hallway to talk to her. I've filed reports at the hospital and by written documentaion about some of the stuff I've seen (ie: dining room of 50 residents with nobody from staff there to watch him, and therefore nobody to tell me how the patient had fallen, when he had fallen, or if he lost conciousness, since I don't speak German and couldn't ask him myself).

As far as educating the nurses go, we've tried to tell the nurses at one nursing home that when a patient falls and is complaining of head/neck/back pain, it's not a good idea to pick them up and move them, but is better to just leave them on the floor to minimize injury. The LPN's response (because nobody could find either of the two RNs that were in the building) was "but the patient isn't comfortable lying on the floor" and to walk off. At one of the nursing homes that every time we go, we have to explain to the same nurse every time that we need the paperwork for the hospital, and each time she's walked off in a huff saying "nobody's ever told me that before." The time we had an arrest there, we told her to just fax the paperwork over, since we weren't going to wait 10 minutes again for her to finish copying it. Our agency has in fact tried to talk to the administrators at some of the area nursing homes about teaching them what they need to do in certain situations (falls, hip fxs, etc) and each time have been turned because "we teach our staff everything they need to know."

So basically, even though I know there are some nursing homes out there, since I have been working in EMS, I have yet to see it.

After my first two gsw's in the field in three weeks I must wonder...is everyone really that bad and trying to kill themselves?

"Were you trying to hurt yourself?"
"yea"
"well you missed"
....
"I can't breath"
"ya dude you have a hole in your chest."

I understand that there are a lot of good nurses/nursing homes out there (I used to volunteer at a good one back in high school), but where I live right now that's not exactly the case. Two nursing homes have been shut down by DOH in the past 3 years for violations of all sorts of stuff, as well as inappropriate care. Two others are on "probation," and the reason the one at least hasn't been shut down yet is because they had such a hard time finding places for all the patients they had to take out of the most recently closed facility, and all the other nursing homes in the area are still overcrowded. There are also a few more in the area that have been on probabtion from Medicare for violations of their regulations.

I've reported nurses to the administrator (about the LPN to the one of very few RNs actually in the building), and as a result she called our office to complain that the crew was being "disrespectful" in front of the patient, when in fact my partner was taking care of the patient, and when the head nurse showed up to make sure we were treating the right one, I took her out into the hallway to talk to her. I've filed reports at the hospital and by written documentaion about some of the stuff I've seen (ie: dining room of 50 residents with nobody from staff there to watch him, and therefore nobody to tell me how the patient had fallen, when he had fallen, or if he lost conciousness, since I don't speak German and couldn't ask him myself).

As far as educating the nurses go, we've tried to tell the nurses at one nursing home that when a patient falls and is complaining of head/neck/back pain, it's not a good idea to pick them up and move them, but is better to just leave them on the floor to minimize injury. The LPN's response (because nobody could find either of the two RNs that were in the building) was "but the patient isn't comfortable lying on the floor" and to walk off. At one of the nursing homes that every time we go, we have to explain to the same nurse every time that we need the paperwork for the hospital, and each time she's walked off in a huff saying "nobody's ever told me that before." The time we had an arrest there, we told her to just fax the paperwork over, since we weren't going to wait 10 minutes again for her to finish copying it. Our agency has in fact tried to talk to the administrators at some of the area nursing homes about teaching them what they need to do in certain situations (falls, hip fxs, etc) and each time have been turned because "we teach our staff everything they need to know."

So basically, even though I know there are some nursing homes out there, since I have been working in EMS, I have yet to see it.


Okay...permission to bang head on the wall :)
I guess, I'm lucky to work where I do. Yes occasionally we get some bad nurses, who shouldn't be permitted to take care of thier dog, let alone a person, but for the most part...I think we give damn good care. I know....the exception to the rule. :o

When treating the Acute pulmonary edema patient found lying supine in a filthy diaper on 1LPM O2 via simple face mask, it may be construed as bad form to throw a pillow behind the nursing station and say "use this next time, it's much faster."

:laugh: :laugh: :laugh: :laugh: :laugh: :laugh:
Almost peed my pants on this one!!

K, I need to stop reading this thread and read my text if I ever plan on finishing school. So quit submitting such entertaining stories!!! ;)

So we had a patient last night with 9/10 abd pain who kept saying:

"Oh my god, it hurts. Why can't you give me anything for the pain? Don't you have phenergan or something?"

I learned that I have the crappiest luck. Last night running on the volunteer fire department (I'm moving in a couple of weeks so I resigned), and I wind up on an accident scene with three victims- two intubations, three IV's and a crike (which if anyone asks the medic did since I'm "only" an EMT-I *whistles* ;) ) in less than 20 minutes.

Even though the grass is the same height, the ground under is not always.

Never make eye contact with fire personal on scene of an MVA after taking a tumble in a ditch, you will most likely see a smile on his lips and his eyes will twinkle a little.

While doing a trauma assessment on a drunk after an MVA don’t ever use the words “tell me if you feel anything” you may possibly get the answer “it feels good when you do that”

Give Alzheimer’s patients something to hold onto other than your body parts.......oh yeah and never lean over Alzheimer’s patients.

All of your experience and skills on the monkey bars as a child will come back to you when moving around the back of a moving ambulance.

When typing a report I know where to find candy in the office at 3:00 am.

I have learned that firefighters absolutely loooove to play with toys, and will disasemble a car just because they can.

Tape is the great equalizer, nobody is exempt from having their hair taped to the backboard.

The first thing I learned is that when you put Armor All on the seats in the back of the ambulance you can and you will fly off them when the driver (who waxed them for you so they would look nice) hits a right turn on a country road.

I have learned that nobody has a more wicked sense of humor than police, fire and ems, they also have a stronger bond between them than I knew.


Note to nursing home staff….when caring for a patient who has fallen in the shower room, move them from behind the door, secondary injuries from head wounds makes our jobs a little harder.

The other night, I met the patient everyone knows.

The other night, I met the patient everyone knows.

We saw a patient lying in the street the other night, who happened to be completely and totally plastered. Everytime we asked him his name, he kept slurring out "you know me," and didn't trust the fact that I had never seen him before in my life. Well needless to say, somebody else must have called 911 before we got there, because when the FD showed up, the first words out of the medic's mouth were "oh, it's you." :rolleyes:

Category: WTF.
See all previous posts regarding Nursing Homes.
Now, read......

Page: my ambulance number, you are needed at X nursing home to transport a patient complaining of a cough, non emergent.

K, out the door we go.

At Nursing home, after talking to three different aids/nurses.

Me: "Did anyone call the ambulance?"

Finally, Nurse X pipes up.......

Nurse: "Yeah, Resident X has had a bad cold for a few days now, and we thought he should have it checked out".

Me: "OK............. where is the resident?"

Nurse: "Down the hall"

Me, looking at several halls filled with residents: "Would you mind showing me?"

Nurse: "(exaggerated sigh) I guess"

Me, after talking with patient and determining that I am not going to get a reliable history, asks the nurse: "So, what's going on with patient x?"

Nurse: "I don't know, not my patient" and walks away leaving myself and my crew in patient x's room, and NOT returning.

So, to spare you more of my horrible scripting, after tracking down the charge nurse, we find out that pt x's nurse is no where in the building, and low and behold, the charge nurse has no clue about this pt. either. This pt's nurse, called the ambulance, then clocked out. Only telling the other staff that she called us and that she was going home. We ended up transporting the pt, then had to wait an hour, per protocol, only to be told that the pt. had a cold, and should be returned to the nursing home. DUH. I want to wring the little twits neck who called in the first place. Talk about a waste of money. Let's hope that this lazy nurse ends up in a nursing home left to rot in a soggy depends, with all kinds of painful ulcers.

(Before anyone starts complaining, please understand that this is ONE nursing home, and ONE lazy nurse that I am complaining about, and that this patient was in no obvious signs of distress and could have waited until the morning to see his primary physician if so needed, but the lazy nurse wanted to leave early and could only do so if the facilities census complied.)

I remember calls like that...and the endless nursing home to dialysis and return calls....I would rather transport someone with a cold before they were at deaths door than the frequent"pt with a cold" who is actually basically dead with chf/sepsis/etc/doesn't know it yet/has a dnr so no als interventions.....I worked in a single ambulance county so we did it all: 911, critical care tyransports/benign interfacility transports/grandma to the doctor's office, etc
not enough real 911 calls and too many middle of the night bs calls so went back to school(pa) and never turned back....still teach medic students but glad that I don't have to do odark30 bs anymore.

odark30 bs

:laugh:
I gotta remember that one.

We get a call to a nursing home for a patient in the post dictal state. We arrive to see said patient sitting in a wheelchair, being supported by a CNA. According to the RN who's standing there, her seizure was ~30 mins ago, she's normally completely oriented, and isn't coming out of it as fast as she usually does. She now just kind of stares blankly at us drooling and unable to support her own head. Looking at the paperwork, she has diabetes. So...

Me: "Have you checked her sugar recently?"
RN: "Yeah, it was 87."
Me: "What time was that?"
RN: "5:00"
Me: "So before the seizure?"
RN: "Yup."
Me: "And you haven't checked it since then?"
RN: "No, why would we do that?"
Me: "Because chances are it dropped since then. Can you get me a glucometer?"
RN: "It wouldn't get too much lower in only an hour."
Me: "Normally no, but she just had a seizure."
RN: "Well that doesn't explain why her sugar would go down."
Me: "Can you please just get me the glucometer?"
RN: "I still don't see why it's necessary."
Me: "If her mental status isn't what it normally is, I'd like to check to make sure. Can you please get me the glucometer?"
RN: "I still don't see why it's necessary."

However, she does go off to get it. And the result is...that's right, 49.
RN: "Well it was 87 before. I don't see how it could drop so much in only an hour. You must have done it wrong."

And even with the number being clearly visible, she insisted on taking it again, with exactly the same result. Her conclusion? It needs to be calibrated.

We get a call to a nursing home for a patient in the post dictal state. We arrive to see said patient sitting in a wheelchair, being supported by a CNA. According to the RN who's standing there, her seizure was ~30 mins ago, she's normally completely oriented, and isn't coming out of it as fast as she usually does. She now just kind of stares blankly at us drooling and unable to support her own head. Looking at the paperwork, she has diabetes. So...

Me: "Have you checked her sugar recently?"
RN: "Yeah, it was 87."
Me: "What time was that?"
RN: "5:00"
Me: "So before the seizure?"
RN: "Yup."
Me: "And you haven't checked it since then?"
RN: "No, why would we do that?"
Me: "Because chances are it dropped since then. Can you get me a glucometer?"
RN: "It wouldn't get too much lower in only an hour."
Me: "Normally no, but she just had a seizure."
RN: "Well that doesn't explain why her sugar would go down."
Me: "Can you please just get me the glucometer?"
RN: "I still don't see why it's necessary."
Me: "If her mental status isn't what it normally is, I'd like to check to make sure. Can you please get me the glucometer?"
RN: "I still don't see why it's necessary."

However, she does go off to get it. And the result is...that's right, 49.
RN: "Well it was 87 before. I don't see how it could drop so much in only an hour. You must have done it wrong."

And even with the number being clearly visible, she insisted on taking it again, with exactly the same result. Her conclusion? It needs to be calibrated.


GRRRRRRRRR...........
These are the situations where I bang my head on the wall. While (briefly) working in a Nursing home a resident had aspirated a pill and needed oxygen, what does the nurse do? Puts her on 2 liters NC, her sats are in the low 80's and she is normally high 90's. I tell the nurse that this resident needs a NRB with high flow oxygen, Nurse looks at me and says "what?" I had to describe the mask to her. She finally finds one, puts it on the patient, then delivers ONLY 2 LITERS VIA NRB!!!!!
Some of these "nurses" should get out of the game. It is hard not to hate nursing home RN's, I know there are still some good ones out there, but the ones around here leave much to be desired. :mad:

We get a call to a nursing home for a patient in the post dictal state. We arrive to see said patient sitting in a wheelchair, being supported by a CNA. According to the RN who's standing there, her seizure was ~30 mins ago, she's normally completely oriented, and isn't coming out of it as fast as she usually does. She now just kind of stares blankly at us drooling and unable to support her own head. Looking at the paperwork, she has diabetes. So...

Me: "Have you checked her sugar recently?"
RN: "Yeah, it was 87."
Me: "What time was that?"
RN: "5:00"
Me: "So before the seizure?"
RN: "Yup."
Me: "And you haven't checked it since then?"
RN: "No, why would we do that?"
Me: "Because chances are it dropped since then. Can you get me a glucometer?"
RN: "It wouldn't get too much lower in only an hour."
Me: "Normally no, but she just had a seizure."
RN: "Well that doesn't explain why her sugar would go down."
Me: "Can you please just get me the glucometer?"
RN: "I still don't see why it's necessary."
Me: "If her mental status isn't what it normally is, I'd like to check to make sure. Can you please get me the glucometer?"
RN: "I still don't see why it's necessary."

However, she does go off to get it. And the result is...that's right, 49.
RN: "Well it was 87 before. I don't see how it could drop so much in only an hour. You must have done it wrong."

And even with the number being clearly visible, she insisted on taking it again, with exactly the same result. Her conclusion? It needs to be calibrated.

"Muscles burn glucose as fuel, or were you too busy studying which way to wipe for your nursing exams to pay attention to A+P?"

This is the reason why I don't hesitate to document my calls and file complaints for incompetence with the state nursing board. I've always said that we should be allowed to wear recording devices like cops do on traffic stops to back up our statements.

Note: You can't put "Nurse in question is really f--king stupid" as the reason you're filing the complaint.

What I want to know is how these nurses pass their examinations.

From my experience it is the Nurses who are just biding their time till retirement that are the culprits here. When I did work at the Nursing home the Nurses did nothing more than pass pills (most of the time just leaving the pills on the patients bedside, eek) and sit at the desk to chart. Very seldom did I see a Nurse actually physically take care of a resident.

Taking a nursing position in a LTC facility is a sure-fire way to lose all those skills that were learned (maybe) while in nursing school. When you see an RN or LPN badge on someone's uniform, you naturally expect a certain level of competence. For those of us who work with emergent/CC patients we have the opportunites to hone our skills every day/night when we show up to work. Are those nurses getting those opportunities? Nope.

I am not defending poor nursing decisions/care. One of the earlier poster's EMS was doing an excellent service by having scheduled sessions to teach the staffs of the various nursing homes how to prepare for the transport of a resident. Personally, I think that nurses who work in LTC facilites should have to complete twice the amount of continuing education hours required of part time nurses. (which is already twice that of full time nurses in my state) Also, a minimum amout of those hours should be dedicated to assessment, O2 delivery sys., facilitating EMS pick up and departure, and calling report to the hospital. 1 nurse : 50 residents w/ polypharmacy makes it hard to do any real nursing care. Unfortunately, LTC facilities aren't as gung-ho about these things as they are about having all the day to day paper work completed.

Taking a nursing position in a LTC facility is a sure-fire way to lose all those skills that were learned (maybe) while in nursing school. When you see an RN or LPN badge on someone's uniform, you naturally expect a certain level of competence. For those of us who work with emergent/CC patients we have the opportunites to hone our skills every day/night when we show up to work. Are those nurses getting those opportunities? Nope.

I am not defending poor nursing decisions/care. One of the earlier poster's EMS was doing an excellent service by having scheduled sessions to teach the staffs of the various nursing homes how to prepare for the transport of a resident. Personally, I think that nurses who work in LTC facilites should have to complete twice the amount of continuing education hours required of part time nurses. (which is already twice that of full time nurses in my state) Also, a minimum amout of those hours should be dedicated to assessment, O2 delivery sys., facilitating EMS pick up and departure, and calling report to the hospital. 1 nurse : 50 residents w/ polypharmacy makes it hard to do any real nursing care. Unfortunately, LTC facilities aren't as gung-ho about these things as they are about having all the day to day paper work completed.

Very good thoughts. I do agree, there needs to be more continuing education. Correct me if I am mistaken, but isn't there a national standard to uphold when you become an RN? I know I have a standard of care to follow, and if I fail to uphold that I could find my arse in a sling. It is an unfortunate situation, not enough money to go around to get, keep, and educate good staff at Nursing Homes. Not enough staff either, very very sad.

A comprehensive "nursing standard of care" is kinda hard to find. I have taken several courses that refer to these nursing standards of care. I recall one CCC instructor talking about international standards of nursing care. Yet, I haven't been able to find the whole document. There is a national "model" nursing act provided by the national council of state boards of nursing. (https://www.ncsbn.org/312.htm)

This non utilization of a universal standard of care may be due to the fact that each state board of nursing governs the scope of practice of their own nurses. Plus, hospital policies are usually much more restrictive than the state's nurse practice act. If you get reported to the state board, they decide your fate.

1) Trailer parks are the shallow end of the gene pool.
2) If you're drunk, in handcuffs, in the back of my ambulance, you DO have a drinking problem.
3) The difference between paramedics and migrant workers is that we have nice navy T-shirts. (how many jobs do you have????)
4) The difference between paramedics and janitors is that we get to stop cleaning to make runs.

The question I can't answer: why "drunk & stupid" isn't a valid chief complaint.

and

"No matter what problem,
no matter how small.
Always remember our motto:
if you call, we haul."

"4) The difference between paramedics and janitors is that we get to stop cleaning to make runs."

and then we get to clean up the runs.....
I had a deal with a former partner that was mutually benefiical:
vommit I clean
crap you clean.
worked out well.

uh,oh I feel a haiku coming on:
vomit on the bus
why did you call us for this
no one who loves drives

if you call, we haul

Not if you can find a reason to get them to sign a refusal. ;) "Look, we'll help you into the car and your friend can transport you"

1. Q. What do you call a young unconsious female?



A. Sweety

drunks are always fun

before EMT school, when I was a lowly lifeguard, I had to fight a drunk guy in a splash pool wile another lifeguard saved his unconsious friend from the bottom of the pool. Why did I have to fight this drunk in 10 foot water, his friend was find and he "didn't need no sav'in." Beer and waterparks do not mix.

A call to the worst NH in the area (see my above post about seizures and glucose levels...) for a patient with "decreased responsiveness and no apical pulses."

According to the nurse, the patient has been breathing noisily for the past couple of hours, and when they just checked her again, couldn't find an apical pulse. After my partner tries unsuccessfully to find one, I go right for the carotid.

RN: "Why are you doing that?"
Me: "To see if she has a carotid pulse. Which she does, but just barely."
RN: "Really? I couldn't find an apical pulse, so didn't think it would make a difference looking for the carotid."


I know apex usually means top...so does anybody know what an "apical pulse" would be? Since to me, "apical" would imply carotid (the highest pulse in the body), but that's evidently not what he was talking about.

He was probably talking about listening for heart sounds....or feeling for the impulse of the heart in the chest. But you're right....sounds like his head was crammed up his ass.

I know apex usually means top...so does anybody know what an "apical pulse" would be?
The apical pulse is that measured directly over the heart.

as soon as you buy food you get toned out. it's an ambulance law.

I work rural EMS and working 24 and 48 shifts is normal...and to continue on the previous post:

- As soon as you take your boots off and get in bed for the night after an afternoon movie marathon without a call...you get a page.

- Or you decide to get a quick shower...your 1st truck gets a page - they head out. This is followed shortly by second a page....you're up now, wet head and all!!! :) Fun stuff!!

- When you are called out for a "Vehicle vs. deer"...it doesn't matter how fast you get to the scene of the accident - you will NEVER get there before the deer "disappears". Somebody's brother, uncle, cousin, mother, etc. has already carried it off. (Seriously...I've worked 5 of these and never actually seen the deer!)

- When you are called out for a "Vehicle vs. deer"...it doesn't matter how fast you get to the scene of the accident - you will NEVER get there before the deer "disappears". Somebody's brother, uncle, cousin, mother, etc. has already carried it off. (Seriously...I've worked 5 of these and never actually seen the deer!)

Or the volunteer firefighters have.....we've carted a few home tied to the top of the hosebed. We learned to tie them down after one fell off the back of the truck when we hit a bump going up a hill.....it hit the road and our junior firefighter (16 y/o) yells out: "Stop the engine! It's trying to make a break for it!" :laugh:

Or the volunteer firefighters have.....we've carted a few home tied to the top of the hosebed. We learned to tie them down after one fell off the back of the truck when we hit a bump going up a hill.....it hit the road and our junior firefighter (16 y/o) yells out: "Stop the engine! It's trying to make a break for it!" :laugh:


We had a call where the car hit and killed two deer. The FD was trying to figure out how to smuggle one of them out with out their assistant chief, who's also the head of the local DOT branch, noticing that one went missing. According to him, the deer needed to stay for when the DOT inspectors came to the site the following day. They told us that because we weren't transporting the patient, we could join in the barbeque if we put the deer on the stretcher and transported it back to our station.