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Tas

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I guess one of my favorites...

You take a guy complaining of foot pain to the ER (at 2:30 am of course), 2 hours later he calls you again from home.

You see, because the doctor put him back into the waiting room and he didn't want to wait, he WALKED BACK to his house, then called 911 (again =/) and when EMS shows up, asked to be taken to a different hospital.

:D lol
 

DSM

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2 guys were in an apartment drinking, one of them "slipped" on a piece of glass and had a 5 inch laceration resting horizontally beneath his left butt cheek gapped about 3 inches wide and deep enough to place my fingers in if I had chosen.

He tried to go to bed not realizing how bad it was.....4 hours later and 1000 cc of blood loss later, the two geniuses call 911. Poor fellow was so drunk that he just sat there on his laceration with his pants around his ankles. We stood him up, bandaged his gaping wound, IV'd him and transported him to the hospital.

We never did get the real story about how he got cut....some things you just don't need to know.
 

southerndoc

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Responded to a nursing home (big surprise) for a cardiac arrest... nurses are doing CPR. As the nurse starts giving us a report, I notice the BVM connected to the O2 machine in the patient's room. Yes, I'm talking about the ones the COPD'ers use that maxes out at 5 L/min. Of course he's still getting his O2 at the regular rate of 3 L/min.

The nurse's report? She says they can't get a blood pressure on him. My partner, being a bigger smartarse than I am, tells her that maybe they should do their compressions a little better and then they could get a blood pressure.

If that's not funny enough, as I changed the BVM source over to our portable O2 tank, I bumped the O2 up to 15 L/min. The nurse then tells me that I can't use that high of a flowrate. "Why not?" "Because he has COPD."
 
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Olanzapine

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Originally posted by Geek Medic


If that's not funny enough, as I changed the BVM source over to our portable O2 tank, I bumped the O2 up to 15 L/min. The nurse then tells me that I can't use that high of a flowrate. "Why not?" "Because he has COPD."
Hmm. Well, forgive my ignorance, but I thought this was a real issue with certain chronic COPDer's. They get dependent on their low oxygen saturation for their respiratory drive, so they no longer ventilate secondary to high CO2. Therefore, when you give them too high of an oxygen saturation, their respiratory drive can stop, requiring you to intubate them. I've always wondered what to do with them in this case (ie watch them on the floor if you get them oxygen, or withhold giving them "too much" oxygen, whatever that means).
 

Robz

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Originally posted by Olanzapine
Hmm. Well, forgive my ignorance, but I thought this was a real issue with certain chronic COPDer's. They get dependent on their low oxygen saturation for their respiratory drive, so they no longer ventilate secondary to high CO2. Therefore, when you give them too high of an oxygen saturation, their respiratory drive can stop, requiring you to intubate them. I've always wondered what to do with them in this case (ie watch them on the floor if you get them oxygen, or withhold giving them "too much" oxygen, whatever that means).
Since they were doing CPR I am pretty sure there was no respiratory drive. :(
 

OSUdoc08

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As far as I am concerned, if you get in my box, you get 02 15 lpm via NRB & an 18 gauge IV. Even if you have COPD. The transport time to the hospital will not affect the hypoxic drive.

I don't think that a prolonged code on scene and during transport will affect the hypoxic drive in an apneic patient, since they currently have an ANoxic drive. I sure hope OLANZAPINE wasn't actually serious about the whole CPR COPD thing.
 

InfiniumEtAl

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quote:
--------------------------------------------------------------------------------
Originally posted by Geek Medic


If that's not funny enough, as I changed the BVM source over to our portable O2 tank, I bumped the O2 up to 15 L/min. The nurse then tells me that I can't use that high of a flowrate. "Why not?" "Because he has COPD."
--------------------------------------------------------------------------------



Hmm. Well, forgive my ignorance, but I thought this was a real issue with certain chronic COPDer's. They get dependent on their low oxygen saturation for their respiratory drive, so they no longer ventilate secondary to high CO2. Therefore, when you give them too high of an oxygen saturation, their respiratory drive can stop, requiring you to intubate them. I've always wondered what to do with them in this case (ie watch them on the floor if you get them oxygen, or withhold giving them "too much" oxygen, whatever that means


---------------------
You use a pCO2 detector and adjust your o2 flow accordingly (Pediatric detectors work great for these pt's b/c they adjust for the higher hemoglobin o2 attraction of neonates and thus leave you in the correct flow rate for an COPD Adult-just check with your EMS Director for your systems "proper" numbers of O2 flow)
 

southerndoc

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Originally posted by Olanzapine
Hmm. Well, forgive my ignorance, but I thought this was a real issue with certain chronic COPDer's. They get dependent on their low oxygen saturation for their respiratory drive, so they no longer ventilate secondary to high CO2. Therefore, when you give them too high of an oxygen saturation, their respiratory drive can stop, requiring you to intubate them. I've always wondered what to do with them in this case (ie watch them on the floor if you get them oxygen, or withhold giving them "too much" oxygen, whatever that means).
Which is worse... Letting them stay hypoxic with a sat of 60% long enough so they code, or bumping their O2 up and knocking out their hypoxic drive thus putting them on a vent for a few days.

A couple of teaching points here:

1. If your patient is hypoxic, give them O2. Lack of O2 kills, knocking out the hypoxic drive does not.

2. The actual prevalence of individuals with true hypoxic drive stimulated respirations is very, very low. It is estimated that less than 1 in 100 individuals have a true hypoxic drive.

3. If you knock out the hypoxic drive, all you have to do is place the patient on a ventilator and gradually wean him/her off the vent until they begin breathing on their own. Yes, this can be a pain in the butt, but what's the alternative? If you withhold O2 in a patient who is hypoxic, you have more chance killing the patient with their marked hypoxia than by killing them by knocking out their hypoxic drive. Imagine withholding O2 from someone you thought had a hypoxic drive, but they were in that statistically unlikely group of 99 in 100 who actually did NOT have a true hypoxic drive.

4. Codes (respiratory and cardiac arrest) deserves 100% oxygen until a blood gas is obtained. Patients can be titrated down to desired oxygen levels once on the vent, in the unit, and an ABG has been obtained. FWIW, usually <50% (generally around 40%) is used.

5. Nobody is advocating throwing a patient on a non-rebreather when their O2 sat is 88% on room air. COPD'ers have low O2 sats. 88% may be a normal sat for a COPD'er... However, not even a COPD'er can approach normal, resting sats of 60-70%.

I hope this clarifies a few things.
 

NontradICUdoc

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2 stories

1) A woman thought that she was havigns a stroke when she stopped feeling her leg. After a couple of minutes talking to her, it was determined that since she was SITTING on her leg all day watching TV, her leg fell asleep. To this she responded: "That never happened to me before"

2) A woman thought she was having a seizure during sex. After some breif inquiry, the EMT had informed the 40 something that she had had her first orgasm. This this her husband, jumped for joy!!!

And for all you guys out there:

A woman calls up because of a burning sensation to her hand. At 3AM. In the winter. Turns out, she had Ben Gay under her fingernails. She wanted to go to the hospital. The crew cheif agreed. When asked why, the crew cheif responded "If she is going to wake me up at 3AM in the winter for this, then she deserves the $600 ER visit bill"
 

southerndoc

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Originally posted by EMT2ER-DOC
"If she is going to wake me up at 3AM in the winter for this, then she deserves the $600 ER visit bill"
I've done this a few times... not to cost patients money, but for the sole reason that it's oftentimes easier to just transport them than to argue with them about not needing to go to the ED.

Of course when we started paramedic-initiated refusals, and when we got the ability to refuse to transport someone, then things changed.
 

david02

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Hi Everyone, I am sorry for my absense,I had a few problems bur all is well now.
I'm glad to be back
***************david
 

bablurp

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We'll just say fish in the rectum. Patient froze a fish, stuffed it in a condom, inserted it in the rectum and let it thaw out. The fins tore through the condom and lodged on his rectum. X-Rays were taken and sure enough there was a fish in the pelvic area.
 

ParamedicDAS

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Well my partner and I have come up with a number of patient DDXs to tell the hospital that the patient is full of you know what without alerting or upsetting the patient

His Favorite = Anal Glaucoma

Mine

If you have a patient whom is normally relatively intelligent but has a momentary lapse in judgement, then they have ACI (Acute Cerebral Insufficiency)

If the patient has a history of being stupid, then they have CCI (Chronic Cerebral Insifficiency)

FTDF = Family Tree Don't Fork

CF = Cerebral Flatulence

GI = Geicoitis (Can be replaced with any other insurance carrier: Progressivitis, Allstatitis, etc)

EDA = Emergency Department Addiction
 
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