# anyone ever have a job with a ruptured breast implant ?



## emt seeking first job (May 16, 2011)

Please tell all. 

As always, leave out any information which would identify the patient in any way, violate HIPAA, your local protocols, or your agencies policies.

B)


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## rwik123 (May 16, 2011)

Why?...

This ought to be one of the stupidest semi pertinent threads ever started.


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## HotelCo (May 16, 2011)

emt seeking first job said:


> Please tell all.
> 
> As always, leave out any information which would identify the patient in any way, violate HIPAA, your local protocols, or your agencies policies.
> 
> B)



They're filled with saline, yes?

Unless there was some sort of traumatic injury that caused the rupture, that also is likely to have caused other internal injuries, what special considerations are necessary?

You'll have some extra fluid that will be absorbed by the body, and a plastic surgeon will need to remove the ruptured shell, and replace it with an intact one, right?

What are you looking for here?


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## nwhitney (May 16, 2011)

rwik123 said:


> Why?...
> 
> This ought to be one of the stupidest semi pertinent threads ever started.



So why click on it and reply?


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## emt seeking first job (May 16, 2011)

nwhitney said:


> So why click on it and reply?



Thank you.


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## emt seeking first job (May 16, 2011)

HotelCo said:


> What are you looking for here?



Anyone else's thoughts or experiences on the topic.

That way, the first time I encounter it, having no experience, I have the benefit of another person's experience.


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## emt seeking first job (May 16, 2011)

rwik123 said:


> Why?...
> 
> This ought to be one of the stupidest semi pertinent threads ever started.



In your opinion.

A semi-pertinent thread is a pertinent thread all the same. Just like a woman 3 weeks pregnent is just as pregnent as a woman 8 months pregnent.


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## Pneumothorax (May 16, 2011)

yes.


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## HotelCo (May 16, 2011)

emt seeking first job said:


> Anyone else's thoughts or experiences on the topic.
> 
> That way, the first time I encounter it, having no experience, I have the benefit of another person's experience.



What thoughts? Is there other traumatic injuries that you can treat? Treat them.

No? Then take them to the hospital, or have them sign off. What are you going to do pre-hospitally for a ruptured implant?


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## nemedic (May 16, 2011)

Thoroughly palpate/test to make sure it is ruptured as opposed to slightly leaking, and compare with the other one to determine the  percentage/degree of rupture. because that is totally important information.


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## medicstudent101 (May 16, 2011)

nemedic said:


> Thoroughly palpate/test to make sure it is ruptured as opposed to slightly leaking, and compare with the other one to determine the  percentage/degree of rupture. because that is totally important information.



Exactly. B)


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## emt seeking first job (May 16, 2011)

nemedic said:


> Thoroughly palpate/test to make sure it is ruptured as opposed to slightly leaking, and compare with the other one to determine the  percentage/degree of rupture. because that is totally important information.



Thank you.


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## emt seeking first job (May 16, 2011)

HotelCo said:


> What thoughts? Is there other traumatic injuries that you can treat? Treat them.
> 
> No? Then take them to the hospital, or have them sign off. What are you going to do pre-hospitally for a ruptured implant?




I was curious if anyone had a first hand account.


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## abckidsmom (May 16, 2011)

nemedic said:


> Thoroughly palpate/test to make sure it is ruptured as opposed to slightly leaking, and compare with the other one to determine the  percentage/degree of rupture. because that is totally important information.



Important, but for whom?  I would think this is an exam best left for the surgeon, honestly.  

How's an implant going to be ruptured?  Car accident?  So imagine for a minute that you have a woman immobilized on the stretcher, transporting to the hospital and you cut away her shirt and thoroughly palpate and test something you have absolutely no clue what you're dealing with?

The assessment comes from noting her report of a problem with the breast, a quick inspection to see if there's an inequality in the size, and in the history:  what kind of implant, behind the muscle or not, the volume, etc.  

I would hate to "thoroughly palpate" and cause the folded up, sharp-edged, ruptured implant to cause damage it hadn't yet, or finish dumping out potentially harmful substance through the rupture by squishing it the rest of the way.

All this, and I haven't even mentioned the patient's dignity.  You don't know what you're looking for, can't do anything about it, and would be fulfilling your obligations by just noting and reporting the problem.  No need to get all personal with the patient and "thoroughly palpate."


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## nemedic (May 16, 2011)

Nope, but I have a second of many hands account.


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## exodus (May 16, 2011)

The dude's joking about feeling up the chick..... lol he's not seriously saying thoroughly palpate.


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## nemedic (May 16, 2011)

exodus said:


> The dude's joking about feeling up the chick..... lol he's not seriously saying thoroughly palpate.



Thank you. I figured it would be obvious that I would be joking, especially since the whole nto being able to do anything pre-hospitally thing was already covered


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## medicstudent101 (May 16, 2011)

J-o-k-e.


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## crazycajun (May 16, 2011)

We have a label for people like the OP. "A sexual harassment lawsuit waiting to happen". You seem very concerned about Femoral pulses, breast implants, etc. The facts are simple, you will likely never have the need for checking femoral pulse. If you feel the need and cannot justify your actions the term "Sexual Assault" comes to mind. Same as with implants. You have absolutely no training or tools in your little bag to help a woman with this type of injury. Furthermore with a little research you would find that implants are very tough. It takes an extreme amount of injury to burst one. My wife has them and I can tell you first hand we did everything we could to destroy them at the doctors office before she had them implanted and it was nearly impossible. It took a very sharp knife several attempts to pierce it and most will auto seal. No offense but I am glad you don't work in my department. The legal troubles you are heading to could bring down an entire EMS system.


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## medicstudent101 (May 16, 2011)

crazycajun said:


> We have a label for people like the OP. "A sexual harassment lawsuit waiting to happen". You seem very concerned about Femoral pulses, breast implants, etc. The facts are simple, you will likely never have the need for checking femoral pulse. If you feel the need and cannot justify your actions the term "Sexual Assault" comes to mind. Same as with implants. You have absolutely no training or tools in your little bag to help a woman with this type of injury. Furthermore with a little research you would find that implants are very tough. It takes an extreme amount of injury to burst one. My wife has them and I can tell you first hand we did everything we could to destroy them at the doctors office before she had them implanted and it was nearly impossible. It took a very sharp knife several attempts to pierce it and most will auto seal. No offense but I am glad you don't work in my department. The legal troubles you are heading to could bring down an entire EMS system.



You're kidding me, right?


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## crazycajun (May 16, 2011)

medicstudent101 said:


> You're kidding me, right?



What part do you think I am kidding about?


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## medicstudent101 (May 16, 2011)

crazycajun said:


> What part do you think I am kidding about?



That whole post. Or at least I hope you are.


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## crazycajun (May 16, 2011)

medicstudent101 said:


> That whole post. Or at least I hope you are.



Not kidding at all. 

I personally know of 4 EMT's that were charged with Sexual Assault for checking femoral pulse with not being able to prove medical need.

Breast implant failure is 1%. Even if it does occur, an EMT has no training to do anything about it. An EMT also has no need to feel the breast.

My experience in the doctors office was real. I had a blast and so did my wife. We threw them against the wall, hit them with books, a hammer, jumped up and down on them, and finally cut them with a knife. (These were samples of course)

The first thing I see most newbies do is try to go above and beyond their training and/or SOP. Trying to play hero does nothing but get you into trouble.


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## HotelCo (May 16, 2011)

crazycajun said:


> Trying to play hero does nothing but get you into trouble.



Ladies, and Gentlemen: I give you one of the best quotes I've ever seen on this site.


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## adamjh3 (May 16, 2011)

crazycajun said:


> We have a label for people like the OP. "A sexual harassment lawsuit waiting to happen". You seem very concerned about Femoral pulses, breast implants, etc. The facts are simple, you will likely never have the need for checking femoral pulse. If you feel the need and cannot justify your actions the term "Sexual Assault" comes to mind. Same as with implants. You have absolutely no training or tools in your little bag to help a woman with this type of injury. Furthermore with a little research you would find that implants are very tough. It takes an extreme amount of injury to burst one. My wife has them and I can tell you first hand we did everything we could to destroy them at the doctors office before she had them implanted and it was nearly impossible. It took a very sharp knife several attempts to pierce it and most will auto seal. No offense but I am glad you don't work in my department. The legal troubles you are heading to could bring down an entire EMS system.



Did the OP say anything about touching people inappropriately?



> anyone ever have a job with a ruptured breast implant ?
> Please tell all.
> 
> As always, leave out any information which would identify the patient in any way, violate HIPAA, your local protocols, or your agencies policies.



...Nope. He's looking for advice on what to do if a specific situation were to come up. How is this any different than asking about a rectal bleed or an abscess on the labia? 


As far as a ruptured implant, if there's external bleeding, do your best to control it with direct pressure. Avoid unnecessary touching (includes palpation of the breast, you're not going to learn anything useful) and explain everything you're going to do before you do it. And do your best to keep your patient covered up if you can.


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## emt seeking first job (May 16, 2011)

crazycajun said:


> We have a label for people like the OP. "A sexual harassment lawsuit waiting to happen". You seem very concerned about Femoral pulses, breast implants, etc. The facts are simple, you will likely never have the need for checking femoral pulse. If you feel the need and cannot justify your actions the term "Sexual Assault" comes to mind. Same as with implants. You have absolutely no training or tools in your little bag to help a woman with this type of injury. Furthermore with a little research you would find that implants are very tough. It takes an extreme amount of injury to burst one. My wife has them and I can tell you first hand we did everything we could to destroy them at the doctors office before she had them implanted and it was nearly impossible. It took a very sharp knife several attempts to pierce it and most will auto seal. No offense but I am glad you don't work in my department. The legal troubles you are heading to could bring down an entire EMS system.



Dude, it was just talk. I was just curious because of my saline question in another thread. When I did a online search I got a lot of hits on ruptured breast implants. 

Regarding the femoral pulse. I was trained to check in severe trauma cases, with shock, and a means to establish a quick systolic, in a mass casualty.

If the scenarion warrented it, according to protocols, and no female member present, I would do a quick head to toe on a trauma patient in front of a partner or patient's family member and the intention would be to asses condition and not gratify myself.



There is a gross distinct difference in asking a question about a real potential scenario and assaulting someone. And also kidding around online with anonymous strangers.


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## HotelCo (May 16, 2011)

emt seeking first job said:


> Regarding the femoral pulse. I was trained to check in severe trauma cases, with shock, and a means to establish a quick systolic, in a mass casualty.



The technique of using the presence of a radial, carotid, or femoral pulse as a means to estimate the level of a systolic blood pressure has been proven false.

Check out this thread on the subject:

http://www.emtlife.com/showthread.php?t=23426


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## emt seeking first job (May 16, 2011)

HotelCo said:


> The technique of using the presence of a radial, carotid, or femoral pulse as a means to estimate the level of a systolic blood pressure has been proven false.
> 
> Check out this thread on the subject:
> 
> http://www.emtlife.com/showthread.php?t=23426



I will, maybe tell NYS DOH that and tell NYC REMSCO that.


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## samiam (May 16, 2011)

emt seeking first job said:


> Regarding the femoral pulse. I was trained to check in severe trauma cases, with shock, and a means to establish a quick systolic, in a mass casualty



Absence of femoral pulse on one side = 

Aortic bifurcation occlusion 
Cardiac Arrhythmia
Cardiac Tamponade
Aortic coarctation
Diabetes

It is definitely not valid to check every patient but I was taught to check Radial, Femoral, Carotid and Dorsalis Pedis for all traumas and diabetes

Source: My mind and Google


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## crazycajun (May 16, 2011)

emt seeking first job said:


> Dude, it was just talk. I was just curious because of my saline question in another thread. When I did a online search I got a lot of hits on ruptured breast implants.
> 
> Regarding the femoral pulse. I was trained to check in severe trauma cases, with shock, and a means to establish a quick systolic, in a mass casualty.
> 
> ...



Your original question regards something you are not trained to treat nor does it have any relevance to your job.

If you are wasting time looking for femoral pulse in a severe trauma you are putting your patient at risk. If it is a lower extremity bleed, use tourniquet and rapid transport. If no lower extremity bleed treat other severe trauma and rapid transport. Using for systolic has been shown to be ineffective.

If you think for one minute a family member that has been convinced by an attorney that you crossed the line in treatment is going to take your side then you are in the wrong field. I also doubt your partner will jeopardize his/her career to save yours.

Although you may see a gross distinct difference, a jury of 12 may not.


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## mycrofft (May 16, 2011)

*OP, sorry I ever suggested this.*

 I suggested this, since the question was raised if saline was better than sterile water, and I mentioned the aspect of whether the contents of a breast implant (cosmetic or reconstructive) could be considered sterile "forever" (versus other medical liquids in containers), and suggested he ask the forum. Not like I tied a hot dog to him and sent him into a pitbull rodeo, I thought at the time. 

Would the subsequent "questions" and replies been as barbed had this been about a male buttock repalcement, a glass eye, or prosthetic arm?

Personally, I have not responded to a case with ruptured implant. My wife had a coworker who had a localized andgeneralized syndrome which was hypothesized to have been linked to her very old silicone implant failing decades after implantation.


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## emt seeking first job (May 16, 2011)

crazycajun said:


> Your original question regards something you are not trained to treat nor does it have any relevance to your job.
> 
> If you are wasting time looking for femoral pulse in a severe trauma you are putting your patient at risk. If it is a lower extremity bleed, use tourniquet and rapid transport. If no lower extremity bleed treat other severe trauma and rapid transport. Using for systolic has been shown to be ineffective.
> 
> ...



The gross difference I mentioned was in discussing this and doing it.

I probably would not do anything in the field that violated protocols.

I work in a system where hospitals are less than 10 minutes away so we tend to just load and go.

I was really just curious. It is a 100% appopriate question for this forum.


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## Sasha (May 16, 2011)

It's the apocalypse. I agree wholeheartedly with crazycajun.


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## Luno (May 17, 2011)

To answer your question, yes, I have had a job with a broken breast implant... Now the rest of the story... We had a surgical tech who worked with us, and he brought in some silicone breast implants, they were played with soooo much, that they eventually both ruptured...   Don't worry, these were non-implanted implants.


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## usafmedic45 (May 17, 2011)

> I personally know of 4 EMT's that were charged with Sexual Assault for checking femoral pulse with not being able to prove medical need.



I call bull:censored::censored::censored::censored: until I see the case citations.  However the comment about newbies playing here was great.  I could not have said it better myself.

To the OP, I've seen a ruptured breast implant a few times, but they were all in deceased persons as part of my research into injury patterns.  It takes a LOT of force to rupture a flexible bag of liquid implanted into (or behind, depending upon the particular procedure used) a compressible and somewhat mobile chunk of fat.


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## emt seeking first job (May 17, 2011)

usafmedic45 said:


> I call bull:censored::censored::censored::censored: until I see the case citations.  However the comment about newbies playing here was great.  I could not have said it better myself.
> 
> To the OP, I've seen a ruptured breast implant a few times, but they were all in deceased persons as part of my research into injury patterns.  It takes a LOT of force to rupture a flexible bag of liquid implanted into (or behind, depending upon the particular procedure used) a compressible and somewhat mobile chunk of fat.



I am just guessing it would only happen with older implants ?

Everything decays.


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## usafmedic45 (May 17, 2011)

There is a defined product life for them, but it's more a matter of sufficient force than anything else. If you hit someone in the chest hard enough to rupture them, chances are good that you're going to do some other serious injury to them.  The cases I mentioned were all the result of aircraft crashes.

There are spontaneous ruptures but I thought you were asking about traumatic rupture since I doubt a spontaneous rupture would present to EMS or even to the ED.


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## emt seeking first job (May 17, 2011)

usafmedic45 said:


> There is a defined product life for them, but it's more a matter of sufficient force than anything else. If you hit someone in the chest hard enough to rupture them, chances are good that you're going to do some other serious injury to them.  The cases I mentioned were all the result of aircraft crashes.
> 
> There are spontaneous ruptures but I thought you were asking about traumatic rupture since I doubt a spontaneous rupture would present to EMS or even to the ED.



I was thinking a traumatic rupture in an older implant.

But as I said, the thought just came to me after my thread about saline and sterile water for external use.


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## usafmedic45 (May 17, 2011)

Yeah, even if you were to be able to tell a difference, it's not going to matter one damn bit in the field since you can't do anything about it.  In other words, note it, report it and move on.


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## Sandog (May 17, 2011)

HotelCo said:


> The technique of using the presence of a radial, carotid, or femoral pulse as a means to estimate the level of a systolic blood pressure has been proven false.
> 
> Check out this thread on the subject:
> 
> http://www.emtlife.com/showthread.php?t=23426



A study of 20 people is hardly proof. Given that statistically, there are always outliers in a sample group, it is possible that the majority of the 20 sampled were outliers. This is not to say that the study has no merit, rather if anything, it shows that current practices involving palpation deserve reevaluation.


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## emt seeking first job (May 17, 2011)

usafmedic45 said:


> Yeah, even if you were to be able to tell a difference, it's not going to matter one damn bit in the field since you can't do anything about it.  In other words, note it, report it and move on.



That is what I intend to do in the field.

In this forum, I wanted to hear stories.

Unless something changed last night, it is not a crime to ask what I asked.

:blink::unsure:


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## Handsome Robb (May 17, 2011)

Sandog said:


> A study of 20 people is hardly proof. Given that statistically, there are always outliers in a sample group, it is possible that the majority of the 20 sampled were outliers. This is not to say that the study has no merit, rather if anything, it shows that current practices involving palpation deserve reevaluation.



It isn't a huge study, but it does disprove the method, in a predominantly if not complete  ICU environment... As a run-and-gun skill in an MCI/Triage situation it makes sense, but 9 times out of 10 it wont be a situation like that, so why not take the time to get a manual bp in a single patient situation? Takes less than 30 seconds.


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## crazycajun (May 17, 2011)

usafmedic45 said:


> I call bull:censored::censored::censored::censored: until I see the case citations.



Google "EMT touched woman inappropriately". I won't give you the names of the people I know that were charged due to confidentiality but I will tell you to do some research in Louisiana. In each case where charges were filed it was considered sexual assault due to nature of incident.


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## emt seeking first job (May 17, 2011)

*What about a victim of a stabbing ?*

Has anyone had a job like that ?

Off the top of my head, I would cover the area with a multi-trauma dressing, wrap it snug with roller guaze, throw on some 02, load and go and take vitals on the way.

Does that go against anyone's sensibilities ?


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## shfd739 (May 17, 2011)

emt seeking first job said:


> Has anyone had a job like that ?
> 
> Off the top of my head, I would cover the area with a multi-trauma dressing, wrap it snug with roller guaze, throw on some 02, load and go and take vitals on the way.
> 
> Does that go against anyone's sensibilities ?



Umm... Why arbitrarily use oxygen?  And why wrap with roller gauze? Whatever that is I don't think you would need it. 

Why are you calling it a "job" and not a patient?


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## mycrofft (May 17, 2011)

*I think that the likelihood of running across traumatic implant failures is nil*

1. FRONTAL IMPACT/anterior-posterior force: great deal of very sudden force, or gargantuan crushing. I'd say you have a deader on your hands. Not sure about torso restrain in a MVA, but probably not airbag deployment. Still, a lot of the type of force to snap your neck or deform your rib cage.
2. Lac or GSW: going to be busy with bleeding, and unless it is selective (lateral grazing GSW, or mutiliation with a sharp object) maybe talking pneumo and/or haemothorax.
3. Barometric change, microwave oven, meteorites, tatooing, slam dancing....naw.
4. Immune response against the envelope ("baggie"): big problems for the pt, but the plastic will be immune.
5. Operative accident on implantation or manufacturing defect: maybe your best chance for a leaker, but any reputable surgeon and his scrub nurse will have inspected that implant three or more times, not to mention a leak showing up on the sterile field. As with manufacture, no idea about work done on the cheap in Thailand or some other cut rate scenario.

But again back to OP: in the short period of field tx, use of SNS versus sterile water for initial irrigation is about even. Might want to check neb meds for compatibility with saline before it's used as the diluent, but I never heard of one that was incompatible.


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## emt seeking first job (May 17, 2011)

shfd739 said:


> Umm... Why arbitrarily use oxygen?  And why wrap with roller gauze? Whatever that is I don't think you would need it.
> 
> Why are you calling it a "job" and not a patient?



EMS responds to a job. The job is getting the patient to the ER without their sitatuin getting worse.

I would strap on 02 and leave it on so long as they tolerated it and had no bad reaction.

The roller gauze would hold the pad in place with a little pressure.


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## HotelCo (May 17, 2011)

Sandog said:


> A study of 20 people is hardly proof. Given that statistically, there are always outliers in a sample group, it is possible that the majority of the 20 sampled were outliers. This is not to say that the study has no merit, rather if anything, it shows that current practices involving palpation deserve reevaluation.



I used that thread as a starting point for further research the OP can do. Not the end all, be all.


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## crazycajun (May 17, 2011)

emt seeking first job said:


> EMS responds to a job. The job is getting the patient to the ER without their sitatuin getting worse.
> 
> I would strap on 02 and leave it on so long as they tolerated it and had no bad reaction.
> 
> The roller gauze would hold the pad in place with a little pressure.



Our job is to respond. We respond to help patients. Our GOAL in an emergency is to get the patient to the ER with getting worse.

You still haven't said why you would use O2. Is this just your preference? If the patient has no oxygen deficiency why would you have a need for O2?


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## abckidsmom (May 17, 2011)

emt seeking first job said:


> EMS responds to a job. The job is getting the patient to the ER without their sitatuin getting worse.
> 
> I would strap on 02 and leave it on so long as they tolerated it and had no bad reaction.
> 
> The roller gauze would hold the pad in place with a little pressure.



Have you ever tried to wrap a roll of gauze around a torso?  It's one of the more difficult things to do.  If a person is stabbed to the chest, the first layer of the dressing needs to be occlusive...plastic or vaseline gauze...maybe one of those snazzy chest seal dressings.

Stab wounds to the torso typically don't bleed that badly on the outside.

Oxygen is only necessary if the patient is showing signs of hypoxia.


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## emt seeking first job (May 17, 2011)

crazycajun said:


> Our job is to respond. We respond to help patients. Our GOAL in an emergency is to get the patient to the ER with getting worse.
> 
> You still haven't said why you would use O2. Is this just your preference? If the patient has no oxygen deficiency why would you have a need for O2?



Is it possib;le the patient has a deficiency unable to be detected by an EMT ?

I would think the 02 would help calm the patient, lessen the possibility of going into shock. I would keep it on so long as no adverse reaction. I would monitor them on the way to the ER.

I am aware people here have disagreed with it, but in my class they said you usually can not go wrong giving them 02. Dont just ignore them, monitor their reaction, but it can generally only help.


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## usafmedic45 (May 17, 2011)

emt seeking first job said:


> EMS responds to a job. The job is getting the patient to the ER without their sitatuin getting worse.
> 
> I would strap on 02 and leave it on so long as they tolerated it and had no bad reaction.
> 
> The roller gauze would hold the pad in place with a little pressure.



So you're going to give O2 when it's not indicated and put pressure to further deflate the ruptured implant.  Great thinking there, genius. <_<


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## emt seeking first job (May 17, 2011)

abckidsmom said:


> Have you ever tried to wrap a roll of gauze around a torso?  It's one of the more difficult things to do.  If a person is stabbed to the chest, the first layer of the dressing needs to be occlusive...plastic or vaseline gauze...maybe one of those snazzy chest seal dressings.
> 
> Stab wounds to the torso typically don't bleed that badly on the outside.
> 
> Oxygen is only necessary if the patient is showing signs of hypoxia.



No, my service sees very little trauma. 

The most significant I have seen is a 12" tear to the inner thigh from being impaled on a fence post. The patient got himself off before we arrived. It was a long deep cut, very little bleeding. 

We through on a huge pad, rolled it to his thigh, gave him 02 and got him to the ER.


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## usafmedic45 (May 17, 2011)

> I would think the 02 would help calm the patient, lessen the possibility of going into shock.



You need to brush up on your basics there my friend.  You don't seem to have a clue.  Instead of wasting your time looking for stories about femoral pulses and fake boobs, why not actually learn the underpinnings of your job?  For someone with 800+ posts in less than a year, you seem to have little to contribute and don't seem to have learned much.



> I am aware people here have disagreed with it, but in my class they said you usually can not go wrong giving them 02.



Your instructors were :censored::censored::censored::censored:ing morons.



> Dont just ignore them, monitor their reaction, but it can generally only help.



Wrong.


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## emt seeking first job (May 17, 2011)

usafmedic45 said:


> So you're going to give O2 when it's not indicated and put pressure to further deflate the ruptured implant.  Great thinking there, genius. <_<



Does giving 02 to someone via nrb or cannula put more pressure on the ruptured implant ? 

(I just dont know, honestly)

Wouldnt it just make the air they inhale have a higher % of 02 ? Does it make them breathe deeper causing more pressure ?

I may be wrong but wouldnt a higher concentration of 02 in the air they breathe make them breathe easier ?

I can see a BVM.


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## emt seeking first job (May 17, 2011)

usafmedic45 said:


> For someone with 800+ posts in less than a year, you seem to have little to contribute and don't seem to have learned much.
> 
> 
> 
> ...



That is merely your opinion.

Thank you for sharing.

Thank you for your concern in what I have or have not learned.

It was enlightening to hear your point of view.


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## abckidsmom (May 17, 2011)

emt seeking first job said:


> Does giving 02 to someone via nrb or cannula put more pressure on the ruptured implant ?
> 
> (I just dont know, honestly)
> 
> ...



I think my 8 year old has a firmer grasp on science than you do.  Please get a real book on anatomy and physiology and read it.  Do not read another bit of your EMS crap textbook, and forget whatever your insane instructors told you in class.

Wanna hear my ruptured breast implant story?  27yof was ejected from a car, but left her arm underneath of it.  She was in our ICU with a closed head injury, pulmonary contusions and ARDS and a liver lac.  We got around to evaluating her ruptured breast implant on the second or third week of her course.  

You really need to spend some time actually learning the science of the basics, and not spinning your wheels on subjects that just. don't. matter.


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## crazycajun (May 17, 2011)

^^^^^^^ This


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## medicRob (May 17, 2011)

Obvious troll is obvious.


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## crazycajun (May 17, 2011)

emt seeking first job said:


> That is merely your opinion.
> 
> Thank you for sharing.
> 
> ...



Pretty much fact as we have all read your post.

You should either try and study more or stick to IFT

I would ask for my money back from the course provider


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## rwik123 (May 17, 2011)

emt seeking first job said:


> I would think the 02 would help calm the patient, lessen the possibility of going into shock.
> 
> in my class they said you usually can not go wrong giving them 02. Dont just ignore them, monitor their reaction, but it can generally only help.



So if I stubbed my toe on the foot of a table you'd hook me up to a non-rebreather at 15 lpm right? I mean i am hysteric from this injury and o2 would defiantly calm me down...right?

The fact that people like you are treating patients everyday is disturbing.

Please go back and take high school intro to bio...maybe if you took that, it would not require you to start 3 threads p/day of questions.


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## lampnyter (May 17, 2011)

Words of every EMT instructor EVER- "Every patient gets oxygen"

Go tell the national registry test that you dont give the patient oxygen. See if you pass.


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## HotelCo (May 17, 2011)

lampnyter said:


> Words of every EMT instructor EVER- "Every patient gets oxygen"
> 
> Go tell the national registry test that you dont give the patient oxygen. See if you pass.



I had a dog, and his name was Cody.


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## lampnyter (May 17, 2011)

HotelCo said:


> I had a dog, and his name was Cody.



And?


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## HotelCo (May 17, 2011)

Oops, sorry. I thought this was the thread where we talked about things that didn't matter.

Would you give Narcan to every patient you come across? After all, it might make them "better"


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## lampnyter (May 17, 2011)

HotelCo said:


> Oops, sorry. I thought this was the thread where we talked about things that didn't matter.
> 
> Would you give Narcan to every patient you come across? After all, it might make them "better"



No. But according to protocol, I can give every patient oxygen.


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## HotelCo (May 17, 2011)

lampnyter said:


> No. But according to protocol, I can give every patient oxygen.



You strike me as the type of person protocols were created for. Wouldn't want you to actually think, and consider if the patient needs it, or not...


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## lampnyter (May 17, 2011)

HotelCo said:


> You strike me as the type of person protocols were created for. Wouldn't want you to actually think, and consider if the patient needs it, or not...



Whether or not the patient "really" needs is doesnt matter to an EMT. EMTs arent even taught how to use a pulse ox. An EMT will never get in trouble for giving a patient oxygen. If the OP wants to give every patient oxygen thats his choice.

Do i give every patient oxygen? No. But i hate seeing people get flamed for doing what they are taught. If its not right it shouldnt be taught. Plain and simple.


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## HotelCo (May 17, 2011)

lampnyter said:


> But i hate seeing people get flamed for doing what they are taught. If its not right it shouldnt be taught. Plain and simple.



Let's break that down.

You seem to grasp that things that aren't "right" are taught in EMT school. You also say, that you don't like seeing someone yelled at for doing something "wrong" that they were taught to do. 

See where I'm going with this? Wrong is wrong, whether it was taught, or they just decided to do it.

Go ahead, follow your protocols. It'll save you from having to make a decision.


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## lampnyter (May 17, 2011)

HotelCo said:


> Let's break that down.
> 
> You seem to grasp that things that aren't "right" are taught in EMT school. You also say, that you don't like seeing someone yelled at for doing something "wrong" that they were taught to do.
> 
> ...



Yes but obviously, there are people that dont know its wrong.


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## rwik123 (May 17, 2011)

its not right what they are getting taught. i have no problem them saying to do it for nremt, but theres no excuse once they get into the field. Give o2 when its indicated by a sign or symptom, don't give it if there isn't any indication. simple. Treat the patient.


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## HotelCo (May 17, 2011)

lampnyter said:


> Yes but obviously, there are people that dont know its wrong.



Obviously.

Why not inform them why it's wrong, instead of just telling them it's okay?


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## lampnyter (May 17, 2011)

HotelCo said:


> Obviously.
> 
> Why not inform them why it's wrong, instead of just telling them it's okay?



Im not saying its okay, im saying people should be complete asses about it.


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## HotelCo (May 17, 2011)

lampnyter said:


> Im not saying its okay, im saying people should be complete asses about it.



This isn't the first time the OP has had issues with medicine. It's obvious, at least to me, that the OP's training was inadequate, and instead of wondering about fake boobs, he should read some medical texts.


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## fast65 (May 17, 2011)

rwik123 said:


> its not right what they are getting taught. i have no problem them saying to do it for nremt, but theres no excuse once they get into the field. Give o2 when its indicated by a sign or symptom, don't give it if there isn't any indication. simple. Treat the patient.




My thoughts exactly, I know that my instructors and the instructors of the basic courses at my college all say "For testing purposes, every patient gets high-flow O2...in reality, evaluate your patient and decide from there." However, I still seem to run into a lot of students that are unable to grasp that concept. 

To the OP, I'm not actually sure if you're a troll or if you just have the mental acuity of one, either way, I have to agree with other members in saying that you should spend a lot more time learning the basics than asking irrelevant questions. I also have a little scenario for you:

You have a 40 yo F pt. c/c racing heart after being left by her husband of 20 years. She has an O2 sat. of 100% and a RR of 34. She denies any SOB but she is also complaining of tingling in her extremities and appears to have carpopedal spasms. Do you give O2?


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## rwik123 (May 17, 2011)

fast65 said:


> My thoughts exactly, I know that my instructors and the instructors of the basic courses at my college all say "For testing purposes, every patient gets high-flow O2...in reality, evaluate your patient and decide from there." However, I still seem to run into a lot of students that are unable to grasp that concept.
> 
> To the OP, I'm not actually sure if you're a troll or if you just have the mental acuity of one, either way, I have to agree with other members in saying that you should spend a lot more time learning the basics than asking irrelevant questions. I also have a little scenario for you:
> 
> You have a 40 yo F pt. c/c racing heart after being left by her husband of 20 years. She has an O2 sat. of 100% and a RR of 34. She denies any SOB but she is also complaining of tingling in her extremities and appears to have carpopedal spasms. Do you give O2?



Im curious to see his response.


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## crazycajun (May 17, 2011)

fast65 said:


> my thoughts exactly, i know that my instructors and the instructors of the basic courses at my college all say "for testing purposes, every patient gets high-flow o2...in reality, evaluate your patient and decide from there." however, i still seem to run into a lot of students that are unable to grasp that concept.
> 
> To the op, i'm not actually sure if you're a troll or if you just have the mental acuity of one, either way, i have to agree with other members in saying that you should spend a lot more time learning the basics than asking irrelevant questions. I also have a little scenario for you:
> 
> You have a 40 yo f pt. C/c racing heart after being left by her husband of 20 years. She has an o2 sat. Of 100% and a rr of 34. She denies any sob but she is also complaining of tingling in her extremities and appears to have carpopedal spasms. Do you give o2?



oh oh oh i know i know. Pick me pick me!!!!!!!!


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## lampnyter (May 17, 2011)

fast65 said:


> You have a 40 yo F pt. c/c racing heart after being left by her husband of 20 years. She has an O2 sat. of 100% and a RR of 34. She denies any SOB but she is also complaining of tingling in her extremities and appears to have carpopedal spasms. Do you give O2?



Sure why not. In testing purposes you would bag her.


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## crazycajun (May 17, 2011)

I bet he is still looking up carpopedal spasms


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## lampnyter (May 17, 2011)

crazycajun said:


> I bet he is still looking up carpopedal spasms



Who?


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## crazycajun (May 17, 2011)

lampnyter said:


> Who?



The OP


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## lampnyter (May 17, 2011)

I dont see how even knowing what carpospasms would help you decide whether you give o2 or not.


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## rwik123 (May 17, 2011)

lampnyter said:


> Who?



Op


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## HotelCo (May 17, 2011)

lampnyter said:


> In testing purposes you would bag her.



HUH?:unsure:


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## crazycajun (May 17, 2011)

lampnyter said:


> Sure why not. In testing purposes you would bag her.



Are you planing on making her pass out faster? Remember 100% O2 sat. RR 34


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## lampnyter (May 17, 2011)

HotelCo said:


> HUH?:unsure:



Test/proctor would say that RR is too abnormal for a female pt. It also depends on the quality of breathing.


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## fast65 (May 17, 2011)

crazycajun said:


> oh oh oh i know i know. Pick me pick me!!!!!!!!



Alright, take a shot at it kiddo



lampnyter said:


> I dont see how even knowing what carpospasms would help you decide whether you give o2 or not.



oh, it's relevant


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## lampnyter (May 17, 2011)

fast65 said:


> Alright, take a shot at it kiddo
> 
> 
> 
> oh, it's relevant



You can tell the patient is hyperventilating without the spasms.


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## HotelCo (May 17, 2011)

lampnyter said:


> Test/proctor would say that RR is too abnormal for a female pt. It also depends on the quality of breathing.



I would ask the proctor if there is any evidence of hypoxia.


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## fast65 (May 17, 2011)

lampnyter said:


> In testing purposes you would bag her.



Ah, but this is not for testing purposes, what would you ACTUALLY do?


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## fast65 (May 17, 2011)

lampnyter said:


> You can tell the patient is hyperventilating without the spasms.



I never said you needed to have the spasms to determine that. They point to a specific syndrome...


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## lampnyter (May 17, 2011)

fast65 said:


> Ah, but this is not for testing purposes, what would you ACTUALLY do?



Oxygen isnt exactly ideal because of the amount of co2 the patient already has but in extreme cases it can help.


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## fast65 (May 17, 2011)

lampnyter said:


> *Oxygen isnt exactly ideal because of the amount of co2 the patient already* has but in extreme cases it can help.


Thank you


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## lampnyter (May 17, 2011)

fast65 said:


> Thank you



90% of basics will give o2 anyways because there is a "breathing problem"


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## fast65 (May 17, 2011)

lampnyter said:


> 90% of basics will give o2 anyways because there is a "breathing problem"



Yes, I realize that, unfortunately


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## crazycajun (May 17, 2011)

fast65 said:


> Alright, take a shot at it kiddo
> 
> 
> 
> oh, it's relevant



Kiddo!!! That's funny

OK. No I would not give oxygen given the assessment. The patient is hyperventilating due to the extreme stress of her husband leaving. She is 100% sat. Adding more oxygen will only advance hyperventilation. I would ask if she has any thyroid problems as Hypocalcaemia can also cause carpopedal spasms. If she has I would admin 2 amps IV calcium gluconate at 10% slow drip over 10 minutes. If not you could use BVM to control breathing w/o O2 but I have found simply talking to a patient and explaining to them what will happen if they do not regulate breathing usually works.


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## fast65 (May 17, 2011)

crazycajun said:


> Kiddo!!! That's funny
> 
> OK. No I would not give oxygen given the assessment. The patient is hyperventilating due to the extreme stress of her husband leaving. She is 100% sat. Adding more oxygen will only advance hyperventilation. I would ask if she has any thyroid problems as Hypocalcaemia can also cause carpopedal spasms. If she has I would admin 2 amps IV calcium gluconate at 10% slow drip over 10 minutes. If not you could use BVM to control breathing w/o O2 but I have found simply talking to a patient and explaining to them what will happen if they do not regulate breathing usually works.



Well, considering that I look like I'm 12, calling others kiddo makes me feel older 

More complex than I was looking for, but the more the merrier, thanks!


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## crazycajun (May 17, 2011)

fast65 said:


> Well, considering that I look like I'm 12, calling others kiddo makes me feel older
> 
> More complex than I was looking for, but the more the merrier, thanks!



Hey I was trained old school. If we had a patient back in the 80's that was hyperventilating we would tell them to control breathing. If they didn't listen we would simply cover the mouth and nose to ummmm (stabilize the head) but this usually caused them to just pass out.


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## mycrofft (May 17, 2011)

*Geez this post got a lot of hits already!*

Woohoo!


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## nemedic (May 17, 2011)

*don't feed teh troll*



mycrofft said:


> Woohoo!



Since I am dumb-founded that nobody has done this already:
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## nemedic (May 17, 2011)

As Samuel L. Jackson would say if he were a paramedic:

"I am sick of the mother :censored::censored::censored::censored:ing pointless oxygen on the mother :censored::censored::censored::censored:ing patient"


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## nemedic (May 17, 2011)

nemedic said:


> As Samuel L. Jackson would say if he were a paramedic:
> 
> "I am sick of the mother :censored::censored::censored::censored:ing pointless oxygen on the mother :censored::censored::censored::censored:ing patient"




Every protocol in the current Massachusetts Statewide Treatment Protocols has a line that states "Administer oxygen using appropriate oxygen delivery device, as clinically indicated." Nowhere in the protocols of the CMRs does it say that a person's mouth/nose are not appropriate delivery devices, as clinically indicated.

http://www.mass.gov/Eeohhs2/docs/dph/emergency_services/treatment_protocols_902.pdf


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## usafmedic45 (May 18, 2011)

> Does giving 02 to someone via nrb or cannula put more pressure on the ruptured implant ?



You are denser than I thought.



> Obvious troll is obvious.



Yup.  Hopefully the ban stick has been swung or will be shortly.


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## MrBrown (May 18, 2011)

Brown has been holding back for long enough

This bloke is a retarded idiot and as such will always excrete vomitus oralus befitting of same


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## MusicMedic (May 18, 2011)

fast65 said:


> You have a 40 yo F pt. c/c racing heart after being left by her husband of 20 years. She has an O2 sat. of 100% and a RR of 34. She denies any SOB but she is also complaining of tingling in her extremities and appears to have carpopedal spasms. Do you give O2?



This brings up another question...


how accurate is that O2 sat? 

ive delt with a few o2 sats that were totally wacked out.. patient looks fine with an o2 sat of 72... 

that and Nail Polish is an o2 sat meters worst enemy..


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## Sasha (May 18, 2011)

lampnyter said:


> Sure why not. In testing purposes you would bag her.



Oh yes, let's give her even more of an anxiety attack then she's having now by putting something occlusive over her face.


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## Sasha (May 18, 2011)

Pleaaaase don't sentence the OP to IFTs, our poor patients already have to deal with burnt out idiot nurses, don't add EMTs who refuse to learn, make their own decisions and grow as a provider to the mess.


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## CAOX3 (May 18, 2011)

MusicMedic said:


> This brings up another question...
> 
> 
> how accurate is that O2 sat?
> ...



1. Her pulse ox wasnt 72.

2. If it was 72  she didn't resemble anything close to fine.

The last time I dealt with a sat that low they were agnonal and as grey as the Seattle skyline.


Wow I  just read this whole thread, and well now I'm contemplating jumping off my balcony.

I actually think I just got stupid in the process.

Thanks.


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## katgrl2003 (May 18, 2011)

CAOX3 said:


> Wow I  just read this whole thread, and well now I'm contemplating jumping off my balcony.
> 
> I actually think I just got stupid in the process.
> 
> Thanks.



I was just thinking the same thing:wacko:


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## LucidResq (May 18, 2011)

Thread closed due to getting off-topic and heading nowhere positive.


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