# Just another crackhead.....



## ttoude (Dec 21, 2009)

Your toned out to a local satellite care facility 50 miles from the main care center for a Rule out P/E. 

Staff says shes just high again (paraphrasing) and she smells awful

A 33 year old female that claims to be a recovering heroin user sits doubled over clutching a personal pillow to her left side on a hospital bed. Smell of feces is strong, dis-shuveled and dirty clothes. Periodically crying out in pain, not asking for any pain meds. A/Ox4 does not talk like a heroin user at all, is alert AWAKE the entire time and is pissed that noone is taking her seriously. 

pain on breathing, keeps that pillow crammed into the left side. Took tylonol, a friends morphine, and heroin with no relife of pain. When ask about pregnency she says her girlfriend would be pissed if she was (thats a no in my book)

says she slept weird on the couch 2 days ago and thats when the pain started. 

What do you think
I'm counting this one as my first "I figured it out as a basic"


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## VentMedic (Dec 21, 2009)

ttoude said:


> What do you think
> I'm counting this one as my first "I figured it out as a basic"


 

I think by the title it already indicates your attitude and the type of care that will be provided.


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## NomadicMedic (Dec 21, 2009)

I'll give you the benefit of the doubt and hope that the "just another crackhead" line isn't yours...

So, give us the vitals and the results of the detailed physical exam and then we'll start kickin' out some DDs.


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## Lifeguards For Life (Dec 21, 2009)

ttoude said:


> Your toned out to a local satellite care facility 50 miles from the main care center for a *Rule out P/E. *
> 
> Staff says shes just high again (paraphrasing) and *she smells awful*
> 
> ...


*
*

how does a heroin user talk?
what exactly do you believe you figured out?


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## Lifeguards For Life (Dec 21, 2009)

also i feel this thread is inappropriate.  I really hope you took this women to the hospital and were decent to her. It's not your job to attempt to modify society's behavior to what you deem socially acceptable. 

Studies of patients who die unexpectedly of pulmonary embolism reveal that they complained of nagging symptoms often for weeks before death related to pulmonary embolism

Under what criteria did you reason that "crackhead" fit her symptoms better?

Did you gather anything medically relevant from your assessment, that was not subjective?


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## ttoude (Dec 21, 2009)

Well before you guys get to far off in the wrong direction... 

The "snap to" reactions are my point exactly. in a group of 6 caregivers I saw beyond the obvious and the stereotypical. 

Some of the clues where the pillow bringing relife, serious-ly ineffective pain killers, and I had the pleasure of being around alot of different people drug addicts included and Herion addicts have a distinctive slow speech pattern and a routine nod off during conversation, Absent in this case.  

Do yourself a favor and the next time you get the chance to TALK to someone in this situation, do so. theres alot to learn from people who have taken a different path.

PT: "People just assume that I'm a junkie and I'm not, I'm in pain and I'm a person" 

EMT: "Truth is sweet heart everybody is an addict, everyone has an addiction, now lets get an ace bandage on that broken rib" 

I've always had a pet-peve about people treating the homeless, disabled and addicts like less than people. thats the point of this post, look deeper


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## Lifeguards For Life (Dec 21, 2009)

ttoude said:


> Well before you guys get to far off in the wrong direction...
> 
> The "snap to" reactions are my point exactly. in a group of 6 caregivers I saw beyond the obvious and the stereotypical.
> 
> ...



my bad for jumpin your :censored::censored::censored::censored:, bud

good job


In the past, we would use compression wraps to help "splint" and immobilize the area. Compression wraps aren't recommended for broken ribs anymore because they can keep you from taking deep breaths, which can increase the risk of pneumonia.


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## VentMedic (Dec 21, 2009)

ttoude said:


> Well before you guys get to far off in the wrong direction...
> 
> The "snap to" reactions are my point exactly. in a group of 6 caregivers I saw beyond the obvious and the stereotypical.


 
I suggest you not to label your thread as *"Just another crackhead".*

We've already had more than our share of BS calls and lizard trucks on this forum.  What would lead us to believe otherwise by your opening post?

Or, do you still feel that way but felt it politically correct to change your tune for the rest of the thread?


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## ttoude (Dec 21, 2009)

VentMedic said:


> I suggest you not to label your thread as *"Just another crackhead".*
> 
> We've already had more than our share of BS calls and lizard trucks on this forum.  What would lead us to believe otherwise by your opening post?
> 
> Or, do you still feel that way but felt it politically correct to change your tune for the rest of the thread?



"Just another Crackhead" illustrates how some people, not all can kinda fall into a rutt when considering other folks situations. 

BTW, It's never been a habit of mine to "Just another" anybody. Like I said do yourself a favor forget the letters after your name, the flat screen TV and whatever kinda car you drive and consider that type of person your equal and you just might be surprised what you learn. 

I spent 5 years as a bike messenger in NYC and I would spend hours talking to the people most consider trash and true you have to watch your back because that addiction is always there. But the incredible stories and experience are a truly cherished and priceless memory of mine. To me they will never be fiends or homeless they are people.

In the end this girl in my care is someones daughter, someones child and I will always treat her as such.


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## medic 112 (Dec 21, 2009)

ttoude said:


> "Just another Crackhead" illustrates how some people, not all can kinda fall into a rutt when considering other folks situations. .
> 
> In the end this girl in my care is someones daughter, someones child and I will always treat her as such.




Great lesson their, well done. 

A lesson i learned very early on while working in a zoo. 
A keeper came in smelling of drink and was feeling very weak, manager wanted to send him home sick and in a bit of trouble when he returns. But if a staff member is going to be sent home sick they have to go through me, He ended up to be Diabetic and never told anyone!!! 

Needless to say all staff he works with now know of his situation and are all fine with it!
Funny how things like that work out.


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## Seaglass (Dec 21, 2009)

I'm a bit confused--was it actually a broken rib?


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## Lifeguards For Life (Dec 21, 2009)

Seaglass said:


> I'm a bit confused--was it actually a broken rib?



fractured ribs are not diagnosed in the field. can be hard to diagnose even with x ray


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## Seaglass (Dec 21, 2009)

Lifeguards For Life said:


> fractured ribs are not diagnosed in the field. can be hard to diagnose even with x ray



Of course--should've rephrased. Was that actually the final conclusion that the people treating the patient reached?


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## ttoude (Dec 22, 2009)

The real point of the story was the caregivers involved that treated her like "Just another crackhead" and yes the most reasonable cause was a separated rib.


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## EMSLaw (Dec 22, 2009)

I am a bit surprised that analgesics gave no relief.  They worked for me! 

Then again, I hadn't spent a lot of time building up a tolerance to opiates.


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## NomadicMedic (Dec 22, 2009)

I'm sure one of the mods will take offense to this and label me a rabble rouser, but I'm confused... was this post written just so you could pat yourself on the back and brag about how good of a caregiver you are?

Or, did you plan on sharing some of the detail of the call and letting the forum members chew on your scenario. (That's the way it usually works.)

Heroin addicts aren't crackheads. Crack addicts are crackheads. They present totally differently.

Secondly, how did you as a basic figure this out? What exactly did you do to determine that this woman was suffering a "separated rib"? What were the clues? What did you do in your exam? What were her vitals? Did you even take a set of vitals or did you just call her "Sweetheart" and give her an ace bandage.

C'mon man, fill us in.

I think we all get your point of "looking deeper", but anyone who's had some real experience in EMS knows how important it is to look beyond the obvious and treat the patient, not the stereotype. 

Maybe this was your first one... if so, congrats on learning the lesson. If you remember it, it'll serve you well in the future.

Also, if you plan on submitting scenarios in the future, it's a help if you lay them out with the chief complaint, vitals and physical assessment findings... then let the group discuss the patient, ask questions and work up a  treatment plan.


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## ttoude (Dec 22, 2009)

n7lxi said:


> I'm sure one of the mods will take offense to this and label me a rabble rouser, but I'm confused... was this post written just so you could pat yourself on the back and brag about how good of a caregiver you are?
> 
> Or, did you plan on sharing some of the detail of the call and letting the forum members chew on your scenario. (That's the way it usually works.)
> 
> ...



Micro management reins supreme. I was waiting for a reply like yours. 
In my short career there has been one consistant, the assumption that _basic_ means inexperienced. Yes most basics are hot shot 21yr olds that will quickly be brought back down to earth by the reality of this job. I'm not one of those hotshots. However I bring some unique experience to the table. 

The crackhead statement was the first thing i heard on scene, not my words. 

I guess that was my first clue to the quality of the staffs assessment of P/E

Again the scenario was about looking past the bs and seeing the problem. Kind like when we did scenarios at work and my pt pulled his gun at shot me and my partner in the gut, lesson learned. 

Each of the scenarios on this forum are meant to teach so by your logic we are all bragging, also are u suggesting theres nothing to learn from a Basic?


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## EMSLaw (Dec 22, 2009)

I think the suggestion is that you didn't actually give us a scenario.


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## NomadicMedic (Dec 22, 2009)

EMSLaw said:


> I think the suggestion is that you didn't actually give us a scenario.



Agreed. I like to learn...and I like to observe how others read clues as they are presented in scanarios.

Just as constructive criticism, perhaps that would have been a better _learning_ scenario if it was presented this way, objectively...without any pejorative comments:

BLS unit has been dispatched to a clinic for a 33 year old female c/o chest pain, r/o PE. Upon arrival, found patient in apparent distress, sitting up on hospital bed, self-splinting left side with a pillow. Pt appears to be unkempt with a strong odor of feces. Staff reports patient has a history of past drug abuse. Pt states she attempted to self medicate with Tylenol, morphine and heroin with no relief. Pt is CAOx3 and is crying out in distress.

*This is where you would give us the REST of the scenario.* HR, BP, respirs, lung sounds, pupils, results of physical exam (I'm assuming you DID do a physical exam and at least palpate the area?) Dig in with AMPLE and OPQRST. All of that fun stuff they told you to check in EMT school. 

The long and short is, if you're going to present a scenario... present a full, objective scenario. See what I mean? 

And no, I never suggested that I couldn't learn from a basic. I don't believe anyone here took that position.


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## Lifeguards For Life (Dec 22, 2009)

n7lxi said:


> y
> *This is where you would give us the REST of the scenario.* HR, BP, respirs, lung sounds, pupils, results of physical exam (I'm assuming you DID do a physical exam and at least palpate the area?) Dig in with AMPLE and OPQRST. All of that fun stuff they told you to check in EMT school.



I'm under the impression there is no "rest of the scenario", as this information has been refused multiple times


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## ttoude (Dec 22, 2009)

Not sure why I bother with internet forums.


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## Lifeguards For Life (Dec 22, 2009)

never mind. i'm not going to say it


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## johnrsemt (Dec 22, 2009)

I don't think people were trying to come down on your scenario,  just where you put it.

I think what people are trying to say is that this is the "Scenario" section.  you present a scenario:  what you are dispatched to, what you find when you get to the patient: including what you see, get in reports, and learn from the patient and the surroundings.
   You can wait a post or two to give Vitals, and skin color and temp,  etc;  but at some point in a scenario those are very helpful.

   If you want to rant and rave about runs and what you get from other EMS providors, and hospital providors;  it should be put into the EMS sections  or BLS sections.


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## Jeffrey_169 (Jan 9, 2010)

ttoude said:


> Well before you guys get to far off in the wrong direction...
> 
> The "snap to" reactions are my point exactly. in a group of 6 caregivers I saw beyond the obvious and the stereotypical.
> 
> ...



You know what you really impress me. I was a young man delivering groceries to a older women because the weather was too bad for her to get and drive. All winter long I delivered her groceries, and she only paid a few cents (because this was all she had) but everyday she would give me a different piece of wisdom to take with me. Rarely do I recall everything she said to me, but sometimes something brings it too mind. I remember once she said to me "Remember son, our place is not to judge nor condemn, but rather to try and understand". I did not fully understand the meaning of this statement, let alone how powerful and true it really is, until I joined my first rescue squad. It did not take long before I got her point. 

I have made more then my fair share of mistakes throughout my life I of all people have no right judging anyone else. I have applied this to my career in the field, and I believe t has made me a better person and a better medic. 

Great post.


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