# Smokers...u gotta love'em!



## divinewind_007 (May 3, 2007)

So a little story of a code i had yesterday....first a litle background info. on patient from previous run.

Pt:
43 year old male
Right lung removed due to MVA x1 year
Emphysema
CHF
Narcotics abuse
Heavy Smoker

Last time i picked him up he was laying on couch with a O2 sat of 50%.
He was breathing about 46 times a minute, couldn't talk, but was still smoking his cigratte. Other crews that have also hauled him said thats how he was everytime they got him too. Always a smoking a cigratte.

Now for our run...critique if you want...always open to suggestion.

Call comes in, dispatcher states bystander CPR in progress.

We jump in the truck...Even got our director to hop in with us. Pt's house on county line 15 minutes out. Director in back went ahead and laid out our stuff. Arrival on scene found pt. lying on couch with sister doing CPR. She stated he had just had a breathing treatment and then just stopped breathing. She had also puked all over him. He apparently managed to at least lite up his cigratte before he crashed because it had burnt his chest a little. I think her puke put it out. 

So we load him up and work him. On Scene Time 7 minutes.

Asstoyle on monitor
Contiuned CPR
Intubated 7.5 tube
Bi-lateral IV's 20 gauge and 18 gauge
3 Epi's on way in
Maxed out on Atropine
1 Narcan
1 Bi-Carb
Finger Stick 132
No change in route to hospital.
Transport time 15 minutes to nearest hospital.

Doctor gave him another round of EPI and he went into Coarse V-Fib.
Shocked once and he came back to normal sinus. Doc. started Dopine drip...3 minutes later he crashed. Doc. worked him about 10 more minutes and then called it. At least he got one last puff on his cigratte.


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## Ridryder911 (May 3, 2007)

Typical COPD and wheezer... good to the last puff!

R/r 911


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## BossyCow (May 3, 2007)

Ridryder911 said:


> Typical COPD and wheezer... good to the last puff!
> 
> R/r 911



Hubby breaks down the COPDers into the Pink Puffers (the skinny ones) and the Blue Bloaters (heavy)


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## Anomalous (May 3, 2007)

BossyCow said:


> the Pink Puffers (the skinny ones) and the Blue Bloaters (heavy)




Wow!!   I haven't heard those terms since Moses was a Medic.


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## Ridryder911 (May 3, 2007)

Actually "pink puffers" are such as emphysema. with barrel chest and thin extremities and those with chronic bronchitis having hypoxemia, and increased CO2 retention, these patients have signs of right heart failure and are known as "blue bloaters."


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## firecoins (May 3, 2007)

Anomalous said:


> Wow!!   I haven't heard those terms since Moses was a Medic.



His # was 5.  Moses was a madman. He would split the sea to get to a call.


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## Onceamedic (May 26, 2007)

*My husband is a COPDr*

His lungs were recked by agent orange in Vietnam....   I hope noone ever calls him a bloater or a whatever the other one was...


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## TheDoll (May 27, 2007)

firecoins said:


> His # was 5.  Moses was a madman. He would split the sea to get to a call.


_that _was a good one!^_^


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## Ridryder911 (May 27, 2007)

Kaisu said:


> His lungs were recked by agent orange in Vietnam....   I hope noone ever calls him a bloater or a whatever the other one was...



What ? How did you come up with that one? I am older than 43 and was too young to go to Vietnam, so unless he volunteered when he was 10 years old something is wrong!.... 

As well, nothing was discussed from Agent Orange, even then most of the Agent Orange cases produced cancerous toxins, not COPD. My brother is a victim of Agent Orange. 
The killer was his lack of ability and persistence not to smoke and obvious lifestyle by choice. 

Blue bloater is an acceptable medical term as describing a patient and has been for at least the past fifty years. One might want to research the terminology before criticizing, such as "barrel chested" and "Thorazine Shuffle" are typical justified descriptions, based upon the presentation of symptoms and appearance of the patient. 

R/r 911


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## medic417 (May 27, 2007)

Smokers are wonderful.  My grandfather a few decades ago almost died quite smoking was doing good.  Then out of the blue started again and then died a slow demeaning death all the while smoking his pipe.  Sometimes you just want to smack em but whats the point.


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## Onceamedic (May 27, 2007)

Ridryder911 said:


> What ? How did you come up with that one? I am older than 43 and was too young to go to Vietnam, so unless he volunteered when he was 10 years old something is wrong!....
> R/r 911




He's 63 with over 125 air assaults to his credit....never smoked...  and the VA has recognized his condition as directly related to his exposure....


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## Ridryder911 (May 27, 2007)

divinewind_007 said:


> So a little story of a code i had yesterday....first a litle background info. on patient from previous run.
> 
> Pt:
> *43 year old male*
> ...



I don't know what scenario your working on? But, the original post was in regards to a  43 year old male with COPD, and contributing factors. Agent Orange was never discussed in the scenario or history. 

Now, if you are regarding another scenario or situation, please discuss it with more information or another scenario. 

R/r 911


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## Onceamedic (May 27, 2007)

wasnt working on any specific scenario.. didnt realize comments on the thread were restricted to the specific scenario...      didnt like the judgementalism....    responded to that....


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## medic417 (May 27, 2007)

Kaisu said:


> wasnt working on any specific scenario.. didnt realize comments on the thread were restricted to the specific scenario...      didnt like the judgementalism....    responded to that....




Have you been in EMS long?  If you have you would realize there are many terms that are used for patients that the uneducated may not understand.  No judging going on, just poster stated what people are refered to because of condition.  Do not take things on this or any site as an attack.


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## Onceamedic (May 27, 2007)

Green as grass... and

fair enough...


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## Ridryder911 (May 27, 2007)

As an EMT you should had been taught the terms "pink puffer" and "Blue Bloater" during your respiratory systems module. As I described they are reference to assist to remember what type of disease they represent. These are not "degrading comments" rather again just description of what the patient may represent. 

As (or if) you decide to go into the medical field, you will see more and more references to symbolic of descriptive terms. This is part of medicine and even disease stages are even defined as similarities..i.e. elephantittis, nurse maid dislocation.  

Medicine does not attempt to be politically correct nor should it be. The point is to be matter of fact, and feelings are subsided for the disease process, while having empathy for the patient. 

For reference in regards to your Agent Orange, you may want to start another post with more information, to assure clarity. 

R/r 911


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## Onceamedic (May 27, 2007)

nope..  never heard them before...    and I did real well in school...  

going to begin paramedic school on August 20....    bet I wont be taught them in medic classes either....


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## Easy (May 28, 2007)

Kaisu said:


> His lungs were recked by agent orange in Vietnam....   I hope noone ever calls him a bloater or a whatever the other one was...



Just to clarify, I think the title of this was "My husband is a COPD'r"
 Took me a while to figure that one out....


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## medic417 (May 28, 2007)

Kaisu said:


> nope..  never heard them before...    and I did real well in school...
> 
> going to begin paramedic school on August 20....    bet I wont be taught them in medic classes either....



Your instructor did not teach you very well then.  I learned those terms as well as others as a first responder, again as a basic, again etc.  As an instructor I use these terms and so do the better text books.  Another one that upsets many is abortion.  Many only use this for the deliberate ending of unborn life, but this term is also used instead of miscarriage in the medical field.  

Again don't be offended.  Open your mind to more and you'll do fine in EMS.


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## Ridryder911 (May 28, 2007)

Kaisu said:


> nope..  never heard them before...    and I did real well in school...
> 
> going to begin paramedic school on August 20....    bet I wont be taught them in medic classes either....



You may have done well in EMT class, but remember that EMT is just above advanced first aid and *not* everything is taught in that one class or possibly your instructor or program lacked teaching something. Remember, the Basic EMT is only written at junior high level as well as even the medic book is only at a high school level, so in comparison in medical academics EMS texts are not regarded very highly.

As well, I hope you don't assume you know what you will be taught or not be taught in medic class since you have yet attended, and then a lot of the true learning will be outside the classroom as in clinical experience. 

If the medical terms blue bloater and pink puffer offend you, then other medical terms as was noted might just as offensive. These terms are not even meant to be offensive, but remember as well EMS is street medicine and the environment is not always the best place for those of the politically correctness. 

I have heard patients referred to as scum, maggots, beached whale, etc. Yes, albeit unprofessional and I do not condone such behavior, these was stated by all level of physicians znd providers. Not excusing such behavior but it can be hard at times to maintain such objective and professional attitude after examining the drug seeker twice in one day, or seeing parents describing they can not afford antibiotics for their child although they have a pack of cigarettes, and then picking up that 600 pound patient the third time this week for "back pain"... 

EMS is definitely not like what is portrayed as on television. It is a job, and that job is to provide quality medical care to those requiring emergency care, and just like any other job it has its down side. 

I really suggest maybe spending some time and getting exposure to the real environment of EMS and emergency care and making sure this is the environment you want to be exposed to, before expanding your career.


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## Onceamedic (May 28, 2007)

I am very fortunate in that I can follow my interests and inclinations without regard to career.....   I have a lifelong interest in medicine and I love the challenge of learning as much as I can about EMS...   I dont know if I will be a good paramedic or not..  I believe I can be...  but you gotta admit there is a ton of egotistical macho BS in the field...  now I understand that people under stress and pressure develope a them against us attitude...  and yep... I can see that bleeding heart attitudes can be rubbed off after a short time in the field....   BUT...  I grew up in an atmosphere of extreme violence, neglect and abuse....  there isnt a whole lot out in the field that will faze me...   I lived on the streets at age 15 -  and I know that a lot of people would have and did write me off....     As far as an open mind goes...     I think I've probably seen both sides of the street...    AND I still dont think its ok to refer to people as their conditions....    I think the term blue bloater is of more harm than help...  BUT hey... . Im learning...  

PS...  I really appreciate you guys (and gals) taking the time to write....


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## BossyCow (May 28, 2007)

Anomalous said:


> Wow!!   I haven't heard those terms since Moses was a Medic.



Yeah... I think that Moses guy was hubby's first partner!


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## BossyCow (May 28, 2007)

Kaisu said:


> I think the term blue bloater is of more harm than help...  BUT hey... . Im learning...
> 
> PS...  I really appreciate you guys (and gals) taking the time to write....




Okay, since it was my post that started this, perhaps I should clarify....... Harm?  What harm?  How does the term in any way harm the pt?  It is a short cut to the signs and symptoms associated with their particular manifestation of their disease.  It's not like I walk into the pt's home and announce over the radio... "All responding units, we have a blue bloater...."  

Also, I am not using the term as a derogatory reference to the patient but as a mnemonic to assist me in their care.  

I am not bitter, or reactionary and using the terms as a way of distancing myself from my patients nor am I of the 'them vs. us' mentality.  

I'm sorry about your husband's medical condition and I apologize for any disrespect you read into my comments.  But, understand... this is an EMS forum, and as such is supposed to be a place where we can discuss things in a frank and open manner.  

We do not discuss people here, but conditions.  We refer to the 'chest pain' we saw last thursday or the "Hip Fx" we treated a week ago.  Is it because we are so jaded that we no longer connect to the human side of our patients?  Of course not.  It's because here, discussing the call, we are more invested in learning, understanding, and interpreting the signs and symptoms so the next time we are on a similar call with someone's Aunt Martha or Uncle Charlie, we can actually make a difference.  

Again, I'm sorry that you chose to interprete my remarks as a personal judgement against your husband's health condition, but prior to completion of your EMS course, I'd see someone about the chip on your shoulder.


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## Onceamedic (May 28, 2007)

Hey I'll be the first to admit that I may have been quick off the mark....   and I like my chip...

and an apology is totally unneccessary...


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## SwissEMT (May 28, 2007)

If EMS gets anymore politically correct, I'm changing careers. 
"Heart Challenge" is the newest term on the block. :wacko:


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## BossyCow (May 28, 2007)

SwissEMT said:


> If EMS gets anymore politically correct, I'm changing careers.
> "Heart Challenge" is the newest term on the block. :wacko:





Hmm... my brain is spinning.. instead of dsyapnic... respiratorially challenged.. or maybe... for an MI... rhythmically impaired... unconsciousness will be referred to as Alternative Awareness..... bleeding out as possible volemicly deficient....... Lights and Sirens will be exercising Auditory and Visual Public Safety Awareness Protocols........ Flat line since it may be offensive to the less endowed female member of EMS will now be referred to as 'waveless'

The following terms are also to be banned...

Juicy veins
Code Brown
Combative - to be replaced with "negative physical  response to Tx"
A&O is too judgemental and subjective and should be replaced with a numeric formula that quantifies the varied levels and areas of cognitive function.. sort of like the Glascow Coma scale only more complicated


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## hitechredneckemt (Jun 7, 2007)

i agree smoking is a bad habit and kills a persons health. but something is going to kill us all reguardless of how healthy we live


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## Pablo the Pirate (Jun 7, 2007)

BossyCow said:


> Hmm... my brain is spinning.. instead of dsyapnic... respiratorially challenged.. or maybe... for an MI... rhythmically impaired... unconsciousness will be referred to as Alternative Awareness..... bleeding out as possible volemicly deficient....... Lights and Sirens will be exercising Auditory and Visual Public Safety Awareness Protocols........ Flat line since it may be offensive to the less endowed female member of EMS will now be referred to as 'waveless'
> 
> The following terms are also to be banned...
> 
> ...



ha ha ha now thats just funny! i love it


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## clinicallydead44 (Jun 13, 2007)

Mmm.. that's like I heard of a call at my agency where this woman was on home oxygen and smoking a cigarette. There's a time when you really need scene safety.. *eye roll* lol.


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## Amack (Jun 18, 2007)

Smokers are what my instructor calls* "Job Security"*


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## DocHoliday (Jun 21, 2007)

*Smoking and EMS Personal*

It is funny to me that EMS people run calls on people that require O2 for smoking for 20+ years and yet outside every staion and base you are sure to find two or three people smoking like smoke stakes.  I know that our is is stressful and there are times of waiting for something to happen but do these people even remember that in ten years they will be the one that needs EMS.  Oh well just a thought.:unsure:


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## medic417 (Jun 21, 2007)

Yup ems smokers will equal pain in the butt patients.  Ems are the worst patients.  Will sedate and intubate so they don't bother me.


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## Amack (Jun 21, 2007)

DocHoliday said:


> It is funny to me that EMS people run calls on people that require O2 for smoking for 20+ years and yet outside every staion and base you are sure to find two or three people smoking like smoke stakes.  I know that our is is stressful and there are times of waiting for something to happen but do these people even remember that in ten years they will be the one that needs EMS.  Oh well just a thought.:unsure:



Great insight!


Sad, but very true.


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## MedikErik (Jul 18, 2007)

We have a LOL in our first due who calls 911 about 3 times a week. Same thing every time, "trouble breathing". And, as always, she's either smoking a cig when we walk in, or trying to hide the remains of the one she was smoking. Says smoking "calms her down" and "helps her breathe". *sigh*.


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## VentMedic (Jul 18, 2007)

DocHoliday said:


> It is funny to me that EMS people run calls on people that require O2 for smoking for 20+ years and yet outside every staion and base you are sure to find two or three people smoking like smoke stakes.  I know that our is is stressful and there are times of waiting for something to happen but do these people even remember that in ten years they will be the one that needs EMS.  Oh well just a thought.:unsure:



I'm sure there are still some hospitals where you will see the Respiratory Therapist and/or Pulmonologist having a smoke in the designated smoking area before they go back to the ICU to intubate someone.


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