# Basics First



## RedBlanketRunner (Nov 10, 2019)

A friend came by to show me her 'spider bite'. Diagnosed as such by an ER doc. It hadn't healed in over a month and she returned to that doc. He said that was typical of some types of spider "poison."

Curious, I did a rudimentary assessment and asked her general past medical history. Bells rang and I did a  glucose check. 210.

And doc, spiders have venoms, glandular secretions, proteins that have various toxic properties. As a rule they are harmless if digested where most poisons aren't.


----------



## CCCSD (Nov 10, 2019)

So now you know more than the MDs?


----------



## silver (Nov 10, 2019)

RedBlanketRunner said:


> A friend came by to show me her 'spider bite'. Diagnosed as such by an ER doc. It hadn't healed in over a month and she returned to that doc. He said that was typical of some types of spider "poison."
> 
> Curious, I did a rudimentary assessment and asked her general past medical history. Bells rang and I did a  glucose check. 210.
> 
> And doc, spiders have venoms, glandular secretions, proteins that have various toxic properties. As a rule they are harmless if digested where most poisons aren't.



Doctors are specifically taught to avoid jargon when possible...


----------



## RedBlanketRunner (Nov 11, 2019)

CCCSD said:


> So now you know more than the MDs. Did you call the physician and tell him how stupid he was?


I work within my level of training. May I respectfully request you do the same.


silver said:


> Doctors are specifically taught to avoid jargon when possible...


I'd like to hear a physician or two weigh in on that. Last I heard, from numerous physicians, is they are not constrained in such fashion. 

But what is interesting here is I get trollish comments directed my way but the rudimentary miss the physician did twice is ignored.


----------



## silver (Nov 11, 2019)

RedBlanketRunner said:


> I'd like to hear a physician or two weigh in on that.



You already have.


----------



## RedBlanketRunner (Nov 11, 2019)

silver said:


> You already have.


More than one as a matter of fact. One a pretty angry physician towards other physicians that didn't spell out to the woman, clearly and in detail, that she was a borderline. She thought the diet they put her on was for weight loss.
He also went so far as to compliment me on my catch. And interestingly, he too is an avid entomologist and we had a nice discussion of arachnid evolution over lunch.


----------



## hometownmedic5 (Nov 11, 2019)

I’ll bet my left kidney, which is my favorite kidney, that right around 0% of that is true. 

You’re not going to make any friends playing the super basic(or medic) card around here. There are straight whacker forums that are little more than an echo chamber for people to congratulate each other. This isn‘t one of them. 

Please try to keep in mind that a sugar at that level is indicative of a problem, but is a far cry from a hair on fire emergency. It’s good that you checked it. Thoroughness is appreciated; but lets pump the brakes on the BLS saves MD routine, k?


----------



## RedBlanketRunner (Nov 11, 2019)

hometownmedic5 said:


> but lets pump the brakes on the BLS saves MD routine, k?


Let's pump the brakes on know all of all doctors the world over. Sounds like that maybe a cop who speaks for every cop in the world, bitter, vindictive, snide and weighs in on medical he is obviously clueless about constantly. 
FYI, many of the docs here get paid $7 per patient visit. The doc I work with most often was trained in Bangladesh and Singapore and does the physician route only to help people. His main trade is in the chemistry field. My other favorite doc was trained in Australia and owns a couple of commercial fishing boats. The doc who took my wife's appendix out did it gratis. Never explained why. It's an entirely different ballgame than in the US. Don't hold the entire world to the standards you happen to know.
You owe me a kidney.


----------



## Peak (Nov 11, 2019)

Let me offer some advice that I didn't receive until I was working in the hospital with an amazing old school EM doc (old school like trained in the 70s, still working, and still compassionate). I certainly didn't appreciate it when I was in the fire service, nor the first level 1 I worked at. 

Talking poorly of another doctor, nurse, paramedics, another hospital, or other departments doesn't make you look better, it actually makes you look worse. The term in the physician community is jousting. You can certainly guide a patient to better care or make recommendations, but talking poorly of others in public just makes you look like a jerk. 

Take all of those ambulance driver vs doctor helper memes on Facebook. They don't make nurses or EMS look more professional. The same goes when you talk poorly of a doctor, nurse, medic, or whomever else publicly. This doesn't mean you can't offer good care or justify why you are doing something different than prior care providers, but you have to be professional about it.


----------



## Tigger (Nov 11, 2019)

RedBlanketRunner said:


> A friend came by to show me her 'spider bite'. Diagnosed as such by an ER doc. It hadn't healed in over a month and she returned to that doc. He said that was typical of some types of spider "poison."
> 
> Curious, I did a rudimentary assessment and asked her general past medical history. Bells rang and I did a  glucose check. 210.
> 
> And doc, spiders have venoms, glandular secretions, proteins that have various toxic properties. As a rule they are harmless if digested where most poisons aren't.


So what is your diagnosis then?


----------



## NomadicMedic (Nov 11, 2019)

Tigger said:


> So what is your diagnosis then?


necrotizing fasciitis secondary to hyperglycemia. 

😁


----------



## akflightmedic (Nov 11, 2019)

@RBR....Just a quick check in, maybe for your benefit, maybe not?

Many of us on here have worked, lived, and played in third worlds or "less".  The majority of us here strive to elevate our profession so that when newbies enter, they see an entirely different side of EMS as opposed to chest thumping hero saves.

We also have many doctors on this very forum...some who were former medics turn doc, some who are docs but love EMS. We have NPs, PAs, CRNA's, RNs, Paramedics, Basics and every other title imaginable contributing in a positive, education, professional format.

The way you keep presenting topics does little to improve our profession, they do little to teach others who do not have the higher education or experience of those I listed. We ALL have done some pretty amazing things...the difference is we do not share them unless there is a lesson to be learned or it is very relevant to the topic at hand, as in improving someone's understanding.

We are happy to hear your perspectives, experiences, and we would love to learn from your encounters to adjust our own care, perceptions or whatever....however, it is imperative that you present it in a professional manner for that bonus learning to occur.

Just my direct opinion from watching your first post to now...


----------



## silver (Nov 11, 2019)

Peak said:


> Talking poorly of another doctor, nurse, paramedics, another hospital, or other departments doesn't make you look better, it actually makes you look worse. The term in the physician community is jousting. You can certainly guide a patient to better care or make recommendations, but talking poorly of others in public just makes you look like a jerk.



...And remember, there is always more than 1 side to a story (especially on the internet).


An EM doc is there to treat emergencies, not diagnose chronic conditions. Did your "friend" go to their PCP after they went to the ED the first time?


----------



## ffemt8978 (Nov 11, 2019)

NomadicMedic said:


> necrotizing fasciitis secondary to hyperglycemia.
> 
> 😁


Or as Dr John Dorian would put it, "Chompers."


----------



## hometownmedic5 (Nov 11, 2019)

ffemt8978 said:


> Or as Dr John Dorian would put it, "Chompers."



I love that episode.


----------



## RedBlanketRunner (Nov 13, 2019)

Tigger said:


> So what is your diagnosis then?


No necrosis evident. Good profusion at the site of the injury but poor profusion and water retention in lower extremities. Doc fired off a battery of tests but I'm out of the loop there. Smells like he's sleuthing for latent chronic.



akflightmedic said:


> We are happy to hear your perspectives, experiences, and we would love to learn from your encounters to adjust our own care, perceptions or whatever....however, it is imperative that you present it in a professional manner for that bonus learning to occur.


I would ask tolerance as well s extend apologies if needed.
It is difficult for much of the medical world to grasp 3rd world medical practice where the hierarchy chain often doesn't exist. Well over half the people I encounter have limited or no access to medical care. Between extremely poor education standards, or no education at all - as my mother in law, for those who are at or below poverty level with basic health care there is usually a queue starting around 03:00, and there are thousands, tens of thousands of stateless people who risk deportation, getting locked up in refugee camps, or press ganged into illegal logging that simply have no access to medical care at all. The governments could not care less about those people. They are cheap labor if they stay in line and healthy, nothing more.
So the NGOs enter the picture. And other stop gaps like field health care workers who often can't send the patients to a regular hospital and deal directly with the physicians who often offer advice and sometimes medication gratis.
It's a major jump shift from the medical world I knew in the States. A whole heck of a lot of free form thinking on your feet and working out how to get a person medical care without trying to get them into a system that doesn't want them.  And people like me cultivate relationships with certain doctors out of necessity both ways. These docs aren't in it for the money obviously. They want to provide care and often throw niceties and even the book out the window.

So what I mentioned about my doc being angry was an understatement. He doesn't just go through the motions. His patients aren't on an assembly line*. He doesn't get perks for pushing meds or specialist diagnostics. And he, and the numerous others with the same mentality appreciate the efforts of people in the field so they can make the connections and often make a real difference.
Take that gal in my other post Alternative EMT stuff. Probable CVA. She's hill tribe. Non citizen. Ice cubes chance in hell she will ever get a scan and diagnosis. That would probably be a years wages. Dozens and dozens of people who need diagnostics and treatment that will never happen. Got HIV? Tough. You can't afford medication. Renal issues? Better hope you won't need a kidney transplant. Amputations? Get by without that part. And on and on and on.

*And that doc, also being an entomologist, knows that for every medically significant spider bite there are several thousand more likely causes. There are only around 10 species of spider that even possess medically significant venom and around 5 that can cause necrosis. Paraphrasing him: "Diagnosing a spider bite without seeing and identifying the spider is like diagnosing a gunshot wound without finding the bullet or having an exit wound".


----------



## RocketMedic (Nov 13, 2019)

Does anyone else smell an odor reminiscent of Mr. Brown in here?


----------



## hometownmedic5 (Nov 13, 2019)

I don’t need either the exit wound or the bullet to diagnose someone as gun shot.

question 1: was there a gun?
question 2: did it go off?
Question 3: was it pointed at this fella when it did/
question 4: has he always had this smoking, bleeding hole in his chest?
Diagnosis: high velocity penetrating trauma to the thorax.

I get that not everybody on earth practices within the environs of a world class academic hospital, but if the doctors in your country have such ****ty training and practices, what in the world is there to suggest that an EMS worker has received such substantially greater training? I’m all for case reviews, and the occasional humble brag is allowable, but if you’re only going to post here about how awesome you are and then argue the point endlessly, can we just not?


----------



## Summit (Nov 13, 2019)

I'm picking up on the OP's posting formula:

I will present someone as making a gross mistake or obvious oversight. Then I'll talk about how I figured it out.

Everyone has stories like that... but if the only stories you tell are variations on that theme...


----------



## akflightmedic (Nov 13, 2019)

This one time, the patient started complaining of the feeling of not being able to breathe. And then they showed obvious signs of discomfort, and his O2 sats started to drop. It was obvious he needed some help. While the doctor and attending called out for a nurse to do something, they then paged respiratory. RT and RN grabbed a non-breather and started fumbling with untangling the tubing, all the while you could sense the panic and urgency in the air as the patient was now extremely anxious and declining in front of our eyes.

I decided to not hold back...all these smart people and nothing was happening....so I reached over and sat the patient upright. Ahhh, immediate relief. The patient calmed down, sats increased, decreased effort to breathe...we all smiled, high fived and thought how close of a call that was!


----------



## ffemt8978 (Nov 13, 2019)

Been a while since I've had to use this.


----------



## medichopeful (Nov 13, 2019)

akflightmedic said:


> This one time, the patient started complaining of the feeling of not being able to breathe. And then they showed obvious signs of discomfort, and his O2 sats started to drop. It was obvious he needed some help. While the doctor and attending called out for a nurse to do something, they then paged respiratory. RT and RN grabbed a non-breather and started fumbling with untangling the tubing, all the while you could sense the panic and urgency in the air as the patient was now extremely anxious and declining in front of our eyes.
> 
> I decided to not hold back...all these smart people and nothing was happening....so I reached over and sat the patient upright. Ahhh, immediate relief. The patient calmed down, sats increased, decreased effort to breathe...we all smiled, high fived and thought how close of a call that was!



I believed your story until you stated "o2 sats."  The vital sign, as any hero knows, is clearly "o2 sTats."  Therefore I have a hard time believing that this actually happened.


----------



## akflightmedic (Nov 13, 2019)

medichopeful said:


> I believed your story until you stated "o2 sats."  The vital sign, as any hero knows, is clearly "o2 sTats."  Therefore I have a hard time believing that this actually happened.



I legit was going to write that!! However, I have such a hard time writing things incorrectly...and it would have pained me daily for years to come had I done that. Especially once the time to edit period has lapsed...it is there forever!


----------



## RedBlanketRunner (Nov 13, 2019)

akflightmedic said:


> This one time, the patient started complaining of the feeling of not being able to breathe. And then they showed obvious signs of discomfort, and his O2 sats started to drop. It was obvious he needed some help. While the doctor and attending called out for a nurse to do something, they then paged respiratory. RT and RN grabbed a non-breather and started fumbling with untangling the tubing, all the while you could sense the panic and urgency in the air as the patient was now extremely anxious and declining in front of our eyes.
> 
> I decided to not hold back...all these smart people and nothing was happening....so I reached over and sat the patient upright. Ahhh, immediate relief. The patient calmed down, sats increased, decreased effort to breathe...we all smiled, high fived and thought how close of a call that was!


Sounds like an incident, physician and assists in ER doing ? with patient. I was at the door wrestling with a stretcher and just saw this group, a commotion, then an ER nurse walk over, drop the head of the gurney and elevate the legs. Problem solved she walked away.


----------



## medichopeful (Nov 13, 2019)

RedBlanketRunner said:


> Sounds like an incident, physician and assists in ER doing ? with patient. I was at the door wrestling with a stretcher and just saw this group, a commotion, then an ER nurse walk over, drop the head of the gurney and elevate the legs. Problem solved she walked away.


----------



## RedBlanketRunner (Nov 13, 2019)

hometownmedic5 said:


> but if you’re only going to post here about how awesome you are


Well, dead honest here, serious max, all my postings of how fantastically wonderful I am carry a degree of irony. Technically, I'm the dregs. I rely on my years of experience, insight, empathy and of course, telepathy to get me through scenarios, normally surrounded by people far better trained and capable than myself. You want chest compressions, put me on it. I can run at any speed the team sup or the doc calls for. Want me to recall what dosage for that patient, I'm close to counting on my fingers and RTs could probably come up with a more accurate guesstimate in half the time. It felt great that I'd always get called to a code in ER. Frees up one person to handle the technical details. Got good compression going? I'm an ace at moving equipment and clearing the trash from the floor without getting in anyone's way. Charting? No problem. Give me the mundane stuff and let the real pros have at it. I'm the end all be all of a code team, logistics wise. I can easily spot if a nurse needs a stool or a piece of equipment will be called for. If  we need ICU staffing assist. Where pieces of equipment could be better placed. Put on the ambulance I usually took lead, doing the periphery while the #2 did the patient. Let me handle the scene and equipment. Let me revert to my old much more familiar role of FF/EMT with years of experience at scene management. You on the patient will get what you need when you need it.

So, appleogies if it is felt required. I'm too old, too jaded, to take things and especially myself dead seriously.  After all the messes I've been in and stupid moves I've made I'm amazed I've still got all my fingers and toes (though a few don't work quite right any more). I'll leave the finicky fussy surly snarly grumpy to you young uns.

Now how about some honesty from other quarters? Working the periphery, in the field or trauma room, how many times have you seen some top pro do a really forehead flattening blunder. -> Hey gal great work, now will you please GET YOUR ARSE OUT OF THAT TRAFFIC LANE! Or, that machine will work a lot better if you plug it in.
Good old lost in the minute details and leave it to the peon to cover them basiks.


----------



## CCCSD (Nov 13, 2019)

You should stay in YOUR lane, instead of trying to call out others...based on your opinion, with no factual basis to create your posts on.


----------



## ffemt8978 (Nov 13, 2019)




----------

