Things I Learned on the Ambulance . . . .

Discussion in 'Pre-Hospital [ EMS ]' started by beanbean, Mar 13, 2004.

  1. beanbean

    beanbean 1K Member
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    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!)
     
  2. DSM

    DSM
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    I have learned why unstable people should not self medicate.
     
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  3. Tas

    Tas Senior Member
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    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!
     
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  4. emedpa

    emedpa GlobalDoc
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    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.....
     
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  5. Tas

    Tas Senior Member
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    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!!!
     
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  6. DSM

    DSM
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    or 2L on a simple face mask:scared: :scared:
     
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  7. emedpa

    emedpa GlobalDoc
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    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.....
     
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  8. DSM

    DSM
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    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:
     
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  9. Tas

    Tas Senior Member
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    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:
     
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  10. mochafreak

    mochafreak registered quaffer
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    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".
     
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  11. Robz

    Robz La Vie Boheme
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    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.
     
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  12. lytesnsyrens

    lytesnsyrens The Phoenix...
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    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.
     
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  13. SMW83

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    :laugh: thats my brother whose the leadfoot EMT driver!!!:laugh:
     
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  14. lytesnsyrens

    lytesnsyrens The Phoenix...
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    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.
     
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  15. OP
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    beanbean

    beanbean 1K Member
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    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.
     
  16. PluckyDuk8

    PluckyDuk8 Pluck of all Plucks
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    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.
     
  17. InfiniumEtAl

    InfiniumEtAl Member
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    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:
     
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  18. Apollyon

    Apollyon Screw the GST
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    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.
     
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  19. InfiniumEtAl

    InfiniumEtAl Member
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    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.)
     
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  20. OP
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    beanbean

    beanbean 1K Member
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    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)
     
  21. OP
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    beanbean

    beanbean 1K Member
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    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.
     
  22. styphon

    styphon Senior Member
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    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
     
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  23. EMT2ER-DOC

    EMT2ER-DOC Why so Serious?????
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    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
     
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  24. EMT2ER-DOC

    EMT2ER-DOC Why so Serious?????
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    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.
     
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  25. medic8m

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    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
     
  26. EMT2ER-DOC

    EMT2ER-DOC Why so Serious?????
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    the "to" line addresses those nurses
     
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  27. medic8m

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    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
     
  28. oudoc08

    oudoc08 Please pass the gas...
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    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.
     
  29. medic8m

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    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).
     
  30. PluckyDuk8

    PluckyDuk8 Pluck of all Plucks
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    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.
     
  31. group_theory

    group_theory EX-TER-MIN-ATE!'
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    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 :)
     
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  32. OP
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    beanbean

    beanbean 1K Member
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    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!
     
  33. EMT2ER-DOC

    EMT2ER-DOC Why so Serious?????
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    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
     
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  34. medic8m

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    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.
     
  35. EMT2ER-DOC

    EMT2ER-DOC Why so Serious?????
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    no worries
     
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  36. 12R34Y

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    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
     
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  37. oudoc08

    oudoc08 Please pass the gas...
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    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...
     
  38. smkoepke

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    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.
     
  39. gwyn779

    gwyn779 stargazer
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    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.
     
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  40. medic8m

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    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.
     
  41. Tas

    Tas Senior Member
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    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.
     
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  42. medic8m

    10+ Year Member

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    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)
     
  43. Tas

    Tas Senior Member
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    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...
     
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  44. medic8m

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    Thanks Tas - Makes sense!

    Now return that flight manual before the feds get suspicous
     
  45. trauma_junky

    trauma_junky 12 step pre-med rehab
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    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).
     
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  46. niko327

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    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."
     
  47. niko327

    10+ Year Member

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    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.
     
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  48. OP
    OP
    beanbean

    beanbean 1K Member
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    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:
     
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  49. Tas

    Tas Senior Member
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    :) 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:
     
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  50. OP
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    beanbean

    beanbean 1K Member
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    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.
     

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