# Absolutely appalled



## medichopeful (Jan 31, 2010)

So I was reading the comments on an EMS1 article and I ran across this one:



> I'm still kinda new to EMS and have only done a few of these. I think the best has to be "Super Morphine" where a EKG patch is placed on a drunk Pt's forehead and said drunk is told "to activate this brand new drug you have to smash this patch with your palm just as hard as you can." Watching drunks beat the crap out of themselves instead of swinging at me has had ER staffers rolling!



Is it just me, or is this one of the most reprehensible posts and admissions possible?  I wish there was a way to find this poster and have his license or certification pulled.  I have reported the comment, and hopefully they do something about it.

Thoughts?


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## VentMedic (Jan 31, 2010)

Not much more appalling than some of the threads here about slamming narcan, arm drop on the face, alcohol in a syringe to shoot up the nose and stuffing ammonia snaps into NRB Masks or straight up the nose.


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## Aidey (Jan 31, 2010)

Alcohol up the nose? That is a new one.

Honestly, at least some of time the people who do some the things Vent listed are just uneducated or were badly taught, they aren't necessarily being malicious. You get a newbie EMT who puts the ammonia in a NRB because that is what his officer taught him, and he's got no idea it is a bad thing.


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## Don Gwinn (Jan 31, 2010)

You know, I must admit that bothered me when I saw it, and I didn't do anything about it.


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## DrParasite (Jan 31, 2010)

While I wouldn't advocate the ekg sticker on the forehead thing, I need to ask:


VentMedic said:


> slamming narcan, arm drop on the face, alcohol in a syringe to shoot up the nose and stuffing ammonia snaps into NRB Masks or straight up the nose.


What exactly is "slamming narcan"?  is that giving the full does of narcan to an unconc person?  or another method?

and the arm drop isn't done with malice, or for the express purpose of causing harm (unlike directing the drunk to hit himself to activate the morpine).  it is used to help confirm responsiveness.  not unlike checking to see if an unresponsive responds to painful stimuli.

alcohol up the nose is def a new one for me, as in ammonia in the NRB.  and the only time I have used ammonia right up the nose method was to my little brother (when he was 14), when he was being extremely annoying, and wouldn't leave us alone as we were doing stuff around the FH.  never did that to a patient.

some people in the field do some weird stuff.  the ER can be just as bad.  ever heard of the "3 F*cks get a tube" rule?


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## VentMedic (Jan 31, 2010)

DrParasite said:


> What exactly is "slamming narcan"? is that giving the full does of narcan to an unconc person? or another method?


Pushing the highest dose of Narcan allowed in your protocols.



DrParasite said:


> and the arm drop isn't done with malice, or for the express purpose of causing harm (unlike directing the drunk to hit himself to activate the morpine). it is used to help confirm responsiveness. not unlike checking to see if an unresponsive responds to painful stimuli.


 
That's great if your patient is indeed faking being unconscious. However, if your patient is unconscious, you may have done damage to their nose or eyes and maybe even the teeth. Now you have a new set of problems to deal with as well as having just abused an unconscious patient. If you break the nose you now risk blood aspiration and have also lost a means of establishing an airway be it NPA or NTI. 




DrParasite said:


> alcohol up the nose is def a new one for me, as in ammonia in the NRB. and the only time I have used ammonia right up the nose method was to my little brother (when he was 14), when he was being extremely annoying, and wouldn't leave us alone as we were doing stuff around the FH. never did that to a patient.


 
When ammonia snaps were taken off most of the ambulances, some replaced these torture devices with alcohol. Some ambulances carried bottles of alcohol which could be used to draw up a little in a syringe. Others preferred the alcohol swabs to stuff up the nose.



DrParasite said:


> some people in the field do some weird stuff. the ER can be just as bad. ever heard of the "3 F*cks get a tube" rule?


 
The doctor can threaten but to actually use a ventilator that might be needed for a critically ill patient on someone for "cussing" and to have that patient now in an ICU for 24 hours where bed space is very limited would have that doctor brought before his peers and possibly the state license review board as well as CMS. Every intubated patient starting in the ED gets tracked for the duration of their stay. If the doctor can justify chemical restraint in the form of sedation, pain management and maybe paralytics along with ETI for addiction withdrawal then that is not abusive and should never be stated with that intent. It is actually a very humane means of helping the patient deal with severe withdrawal by keeping them totally sedated for up to 4 days. One should not confuse that with blatant abuse.


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## emt_angel25 (Jan 31, 2010)

uh i had a partner one time jam a 14g catheter in the back of some gals hand. do you wanna know why? "cause shes been ignorant, and shes drunk, and im the medic and i can do it just because i want to"  

was it right? absolutely not but when your drunk and you have done nothing other than make caring for you a complete pain in the butt its a little bit easier to think....hmmmmmm.....they have tortured me so why cant i to them? 


i dont think any of the above postings are right by any means but id be lying if i said i havent done and/or thought about some of them. (the hand drop test on a "unresponsive" pt who we were watching open her eyeballs) (( still not right, i know))


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## JPINFV (Jan 31, 2010)

emt_angel25 said:


> uh i had a partner one time jam a 14g catheter in the back of some gals hand. do you wanna know why? "cause shes been ignorant, and shes drunk, and im the medic and i can do it just because i want to"
> 
> was it right? absolutely not but when your drunk and you have done nothing other than make caring for you a complete pain in the butt its a little bit easier to think....hmmmmmm.....they have tortured me so why cant i to them?
> 
> ...




Hopefully some paramedic tortures you just because they think that you're faking being altered or because they don't think that your complaint is worthy of their time. Just because a patient is being a pain doesn't justify even the thought of revenge.


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## emt_angel25 (Jan 31, 2010)

i never said revenge nor have i pulled such a stunt or would i ever just cause i was the medic on scene. its a disgusting abuse of power.


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## Akulahawk (Jan 31, 2010)

Slamming Narcan? That's a _*GREAT*_ way to get your opiate OD patient pissed off at you...

Yeah, go ahead and give that patient the full dose as a single bolus... and flush it as fast as you can... just as if it's Adenosine... You go right ahead... I'll be in the next county over while your patient proceeds to pummel you...

Even if your patient doesn't pummel you, slamming the Narcan can (and WILL) bring on some EXTREMELY strong withdrawl symptoms. It's about as unkind as you can be to an OD patient.


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## VentMedic (Jan 31, 2010)

Akulahawk said:


> Slamming Narcan? That's a _*GREAT*_ way to get your opiate OD patient pissed off at you...


 
It is often done just as the crew is about to enter the ED to get revenge on the ED staff or as a joke of some sick type that has gotten several RNs and Doctors injured.


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## mycrofft (Jan 31, 2010)

*Ammonia isn't a torture device any more than any other medical device.*

It is its abuse that causes patient abuse, and it is a combination of abusive practitioners and abusive patient's complaints listened to by management that have made it off limits.

IF you clinically need to establish unconsciousness, ammonia inhalants have a long and safe history and can do the job IF you do not abuse them or the pt. In my experience sternal rubs are not always adequate and (speaking as a pt) they hurt and leave marks. Pinching earlobes, hyperextending joints over pens...bad juju.

There are things you can do with adhesive tape, alcohol wipes, sharps, elastic bandage or even just driving technique that will make you scream for Mommy.

NOT that I've ever done them.:glare:

On purpose.


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## DrParasite (Jan 31, 2010)

emt_angel25 said:


> uh i had a partner one time jam a 14g catheter in the back of some gals hand. do you wanna know why? "cause shes been ignorant, and shes drunk, and im the medic and i can do it just because i want to"
> 
> was it right? absolutely not but when your drunk and you have done nothing other than make caring for you a complete pain in the butt its a little bit easier to think....hmmmmmm.....they have tortured me so why cant i to them?


you know, this reminds of me something a police officer once told me:  as long as there are no TV crews or cameras watching, a police officer can pretty much do whatever he or she wants without fear of reprisal.  

is it right?  in most cases, no.  I will not defend any of such actions, including those that aren't nice, pleasant, and in the best interests of said person in custody.  there are also "station house adjustments" which generally aren't exactly what the law specifies. But just like how in some EMS systems the non-critically ill people walk to the ambulance (regardless of condition), I will say things do happen, and they have happened before I got into this field, and will probably happen long after i retire.


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## VentMedic (Jan 31, 2010)

mycrofft said:


> IF you clinically need to establish unconsciousness, ammonia inhalants have a long and safe history and can do the job IF you do not abuse them or the pt.



I haven't seen them on any ambulance in the area since the 80s and we definitely do not keep them in the EDs. Too many people have reactive airway disease, including staff, that can be triggered to become a life threatening event. 



mycrofft said:


> There are things you can do with adhesive tape, alcohol wipes, sharps, elastic bandage or even just driving technique that will make you scream for Mommy.
> 
> NOT that I've ever done them.:glare:
> 
> On purpose.


 
Oh yeah...

Tape across the eyebrows. Reckless driving with just the "eyebrows" taped to the board. Stretcher drop.


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## Akulahawk (Jan 31, 2010)

VentMedic said:


> It is often done just as the crew is about to enter the ED to get revenge on the ED staff or as a joke of some sick type that has gotten several RNs and Doctors injured.


Indeed... This is not something I'd condone. If you want to get some kind of revenge or play a joke on an ED staff, there are better, less injurious ways to do it.


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## ExpatMedic0 (Jan 31, 2010)

I still do not see how extending the patients arm above there head and letting it go is considered "not appropriate.' I use this method along with a sternal rub and its not to mess with the pt. or be cruel. I was trained to do this in EMT-B, EMT-I, and EMT-P by instructors preceptors and even hospital staff. I can tell you I have never broke teeth or a someones nose by doing this and I think thats a pretty far fetched concept when you look at the MOI for such an injury, have you ever been gently slapped in the face by a limp hand? If so did it break your nose and teeth... come on!


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## JPINFV (Jan 31, 2010)

emt_angel25 said:


> i never said revenge nor have i pulled such a stunt or would i ever just cause i was the medic on scene. its a disgusting abuse of power.



Err...


emt_angel25 said:


> i dont think any of the above postings are right by any means* but id be lying if i said i havent done *and/or thought about some of them. (the hand drop test on a "unresponsive" pt who we were watching open her eyeballs) (( *still not right, i know*))



Emphasis added.


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## VentMedic (Jan 31, 2010)

schulz said:


> I still do not see how extending the patients arm above there head and letting it go is considered "not appropriate.' I use this method along with a sternal rub and its not to mess with the pt. or be cruel. I was trained to do this in EMT-B, EMT-I, and EMT-P by instructors preceptors and even hospital staff. I can tell you I have never broke teeth or a someones nose by doing this and I think thats a pretty far fetched concept when you look at the MOI, have you ever been gently slapped in the face by a limp hand? If so did it break your nose and teeth... come on!


 
The human arm is actually quite heavy in an unconscious patient and if you ever had to restrain it to keep from falling off the stretcher, you would know this.  Also, the patient might be wearing a bulky watch, bracelet or rings that can do even more damage.   You are also still a new Paramedic that is still completing your education so consider yourself very lucky that you have not injured a patient yet.    

Dropping the arm across the face is like doing the witch in the deep lake test.  If the person lives, they are a witch.  If they are innocent, they drown.  Thus, if the patient is faking being unconscious, they pull the blow away from their face.  If they are actually unconscious, they may be injured. 

Keep doing this practice and I can guarantee you will eventually have to answer for your actions.  Your medical director may also not be so quick to back you up unless he/she is stupid enough to put it in writing as an acceptable protocol.   Of course when something adverse does happen, it wouldn't be too difficult to get an expert witness like Dr. B. Bledsoe who has written several articles on the subject or someone with similar qualifications.


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## mycrofft (Jan 31, 2010)

*How and when is it OK to adminster pain PRN?*

Excuse me, noxious stimuli.

I wrote and created a powerpoint presentation in class aimed at teaching law officers about altered levels of consciousness and how/when it needs to be assessed. Street EMS has many of the same problems. Sometimes, often for your own safety as well as the pt assessment, you have to know if they are truly "out", and how deeply, and you don't want to get your hands near their mouths or allow them the opportunity to "accidentally" flail and take a cheap shot as they "awaken" or "have a seizure".

Needless to say there were jokes about using tasers, OC spray, and handcuffs to elicit responses. (_*Tapping*_ the sole of the foot, or over the Achilles tendon with a baton without warning the subject works, but that doesn't look right and can cause bystander charges of assault).There are cultural biases to overcome but abuse is not conscionable.

And yeah the dropped arm thing is prone to causing pt injury.


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## mycrofft (Jan 31, 2010)

*PS: about NH3 in the ER..*

My short career in the ER was in the late Eighties. SOmeone had gone and thoughtfully taped the "poppers" in each treatment bay. Being the newbie I went around and noticed some looked different.
They were amyl nitrate.


Follow your protocols, don't torture your patient, bottoms lines.


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## reaper (Feb 1, 2010)

VentMedic said:


> I haven't seen them on any ambulance in the area since the 80s and we definitely do not keep them in the EDs. Too many people have reactive airway disease, including staff, that can be triggered to become a life threatening event.
> 
> 
> 
> ...



I have had inhalants on the trucks, in the last 3 services I have worked for. Are they used that often anymore? No. But, they are still carried on the trucks.

I have seen many a EMT and Medic fired, for using an arm drop test. I have seen to many broken noses from this and a few black eyes!


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## ExpatMedic0 (Feb 1, 2010)

I was an EMT for 6 years before I was a medic AND last time i checked this was also an EMT-B method not a paramedic specific one. Yes I know first hand about the weight of a human arm, more than you probably since I took boxing for quite some time.
Your absolutely over reacting about this concept and its silly, all the education and paramedic training in the world cant teach some people common sense. Although in your mind I am sure common sense is a 101 level class that is taught only at the bachelors degree level.

PS:
I am the one that uses it so I HAVE MORE EXPERIENCE than you in this particular subject. 



VentMedic said:


> The human arm is actually quite heavy in an unconscious patient and if you ever had to restrain it to keep from falling off the stretcher, you would know this.  Also, the patient might be wearing a bulky watch, bracelet or rings that can do even more damage.   You are also still a new Paramedic that is still completing your education so consider yourself very lucky that you have not injured a patient yet.
> 
> Dropping the arm across the face is like doing the witch in the deep lake test.  If the person lives, they are a witch.  If they are innocent, they drown.  Thus, if the patient is faking being unconscious, they pull the blow away from their face.  If they are actually unconscious, they may be injured.
> 
> Keep doing this practice and I can guarantee you will eventually have to answer for your actions.  Your medical director may also not be so quick to back you up unless he/she is stupid enough to put it in writing as an acceptable protocol.   Of course when something adverse does happen, it wouldn't be too difficult to get an expert witness like Dr. B. Bledsoe who has written several articles on the subject or someone with similar qualifications.


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## VentMedic (Feb 1, 2010)

schulz said:


> I was an EMT for 6 years before I was a medic AND last time i checked this was also an EMT-B method not a paramedic specific one. Yes I know first hand about the weight of a human arm, more than you probably since I took boxing for quite some time.
> Your absolutely over reacting about this concept and its silly, all the education and paramedic training in the world cant teach some people common sense. Although in your mind I am sure common sense is a 101 level class that is taught only at the bachelors degree level.
> 
> PS:
> I am the one that uses it so I HAVE MORE EXPERIENCE than you in this particular subject.


 
Hopefully your patients aren't injured by your failure to grasp this very simple concept as to how you can harm them.

As a Paramedic, you should shake the bad habits you learned by being an EMT-B for 6 years. Yet another good example as to why it is important to get as much education as you can instead of all that "street medicine" so you can understand the difference between dangerous practice and the correct way of providing safe care for your patients.


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## ExpatMedic0 (Feb 1, 2010)

Its taught in college classrooms by EMS educators with at least bachelors degrees .... Where do you think I learned it? Did you think I thought one day "hey this may harm my patient lets give it a try?
your point is completely irrelevant and I will continue to listen to the EMS educators I had in college, and first hand experience instead of a forum troll on the internet.


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## DrParasite (Feb 1, 2010)

VentMedic said:


> Hopefully your patients aren't injured by your failure to grasp this very simple concept as to how you can harm them.
> 
> As a Paramedic, you should shake the bad habits you learned by being an EMT-B for 6 years. Yet another good example as to why it is important to get as much education as you can instead of all that "street medicine" so you can understand the difference between dangerous practice and the correct way of providing safe care for your patients.


ok, i'll bite..... what tests would you used to decide it a person is faking unconsciousness vs truly unresponsive?  and lets assume the patient is hemodynamically stable


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## VentMedic (Feb 1, 2010)

schulz said:


> Its taught in college classrooms by EMS educators with at least bachelors degrees .... Where do you think I learned it? Did you think I thought one day "hey this may harm my patient lets give it a try?
> your point is completely irrelevant and I will continue to listen to the EMS educators I had in college, and first hand experience instead of a forum troll on the internet.


 
It was taught in YOUR EMT class as you stated in an earlier post as a BLS skill in YOUR EMT class. That does not mean everyone advocates it nor is it taught everywhere.

I suppose you will have to learn the hard way by actually harming a patient and that is very unfortunate.


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## VentMedic (Feb 1, 2010)

DrParasite said:


> ok, i'll bite..... what tests would you used to decide it a person is faking unconsciousness vs truly unresponsive? and lets assume the patient is hemodynamically stable


 
Remember this thread?

http://www.emtlife.com/showthread.php?t=16100&highlight=faking+unconscious


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## DrParasite (Feb 1, 2010)

actually no, i didn't.  But after rereading it, you basically would send a person in the condition i just described to the ER, with ALS, and treat them as an unconscious/unresponsive right?  I just want to make sure I understand your position.


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## ZVNEMT (Feb 1, 2010)

if you're worried about the hand drop injuring the Pt, perhaps maybe you dont drop it from fully extended or shield their nose with your free hand. i could be wrong being that i don't have much experience outside of simple transport, so feel free to correct me if I am wrong.

and the "super morphine" thing is pretty bad... i'll leave it at that....


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## firetender (Feb 1, 2010)

*Humans is Humans*

Thankfully, there are many of us who are appalled by such actions. Otherwise they would be much more widespread.  

But the truth is, our profession is an extreme one. It is right up there with the most high-adrenaline of careers. Such careers attract people who are, let's just say, a bit on the edge between on and off kilter. Do you think everyone enters the arena where Life battles Death because they are sane?

There are a lot of people in the general population who have quiet little twists to their personalities that when given free reign can really get out there and  become incredibly painful to others. No less a proportion of that population is part of EMS, and to be straight with you, I think it attracts a lot more people on the edge than does something like Accounting! 

_*What EMS provides is OPPORTUNITY because, by definition, the population it serves is vulnerable.*_ In high volume areas I have seen time and time again reprehensible actions toward human beings "just because" they are not the people who are deemed _really _in need. Donning layer after layer of emotional protection often leads to indifference to suffering; probably the most destructive of all behaviors a medic could display. And this, for the most part, is done subtly and secretly and not observed by others.

The actions themselves as described are of little importance to me. I, myself have taken many of them. And, yes, there were moments when I performed them with a touch of glee! This is the very thing that I deplore most because it is a weakness I have seen in myself. To me, then, it is not the actions as much as it is the attitude behind them. You can start an IV for spite if you want to, all you have to do is know how to call in for the orders.

And this is what I see as the BIG danger because there are those amongst us who, given the least amount of encouragement ("We'll teach him to waste our time!") or opportunity will de-humanize their patients. We get to see examples of this "slip in" to the threads here now and again. 

My only point is, if we're going to be honest we'll have to admit even riding white horses will attract people who do weird stuff with their spurs.


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## Lvillemedic (Feb 1, 2010)

http://theemtspot.com/2009/07/04/test-for-unconsciousness-the-hand-drop/

This is the correct way to do it and is the way I was taught in the mid 80's and again when I got my P cert. I still use it and will contiue to use it. I have never had a pt injuried by this in 26yrs doing ems. I don't consider myself lucky, I just do it correctly. If you do something remember 2 things: 
1. Be able to justify it in a court of law.
2. Make sure you do it correctly and document it well.

Do these two things and you won't have any problems.


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## emt_angel25 (Feb 1, 2010)

JPINFV said:


> Err...
> 
> 
> Emphasis added.



ok unless you count the "hand drop" a cruel and unusual punishment on a consious pt. im talkin the big time stuff.


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## rescuepoppy (Feb 1, 2010)

We have too many chances in the day to day interaction with our patients to accidently cause injury that we do not need to be doing the type of things too many use as a punishment. This type of thing is just another reason we as a whole are losing procedures that we could be using to help our patients. In my opinion every provider that is found guilty of using any procedure as a means of retaliation against a patient should be subject to disciplinary actions. Their is no place in any form of medicine for this type of behavior.


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## ExpatMedic0 (Feb 1, 2010)

Yes I have not had any problems with it either and found it interesting that it was even mentioned in this thread. Obviously like any procedure it must be done properly and used as part of an overall patient assessment to include other hands on assessments and diagnostic tools with pt. hx to reach a conclusion. 
For those that do not like it, different strokes for different folks but its far from malfeasance, negligent or "appalling" Its a tool that can be used.



Lvillemedic said:


> http://theemtspot.com/2009/07/04/test-for-unconsciousness-the-hand-drop/
> 
> This is the correct way to do it and is the way I was taught in the mid 80's and again when I got my P cert. I still use it and will contiue to use it. I have never had a pt injuried by this in 26yrs doing ems. I don't consider myself lucky, I just do it correctly. If you do something remember 2 things:
> 1. Be able to justify it in a court of law.
> ...


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## VentMedic (Feb 1, 2010)

Lvillemedic said:


> http://theemtspot.com/2009/07/04/test-for-unconsciousness-the-hand-drop/
> 
> This is the correct way to do it and is the way I was taught in the mid 80's and again when I got my P cert. I still use it and will contiue to use it. I have never had a pt injuried by this in 26yrs doing ems. I don't consider myself lucky, I just do it correctly. If you do something remember 2 things:
> 1. Be able to justify it in a court of law.
> ...


 
We did a lot of things in the 80s that are no longer done in the year 2010. You seem to want to live in the past. Medicine moves forward even if some in EMS try not to. Try to get up to speed and stay current. There are reasons why some things are no longer done or considered acceptable. It also makes some in EMS look rather stupid to continue doing things that others have stopped long ago because they understood the reasons "why". 

Even the "blog" page you posted states this:



> And while this last part should go without saying, I’m going to put it in here anyway. No test is completely accurate regarding level of consciousness. People presenting with altered mental states and verbal unresponsiveness need to be treated as unconscious regardless of our suspicions based on tests such as these.​
> If you develop the habit of blowing off your patients because they fail tests like the hand drop and the face flick, you’re bound to get caught with your proverbial clinical pants down sooner or later. A bad day indeed.​


 
If the test may not be accurate anyway, why do something that could potentially do harm? It is also ironic that the top of the page states: Medicine moves fast....keep up.   Yet, it advocates stuff done in the 80s and for most, stayed in the 80s.​ 


schulz said:


> Yes I have not had any problems with it either and found it interesting that it was even mentioned in this thread. Obviously like any procedure it must be done properly and used as part of an overall patient assessment to include other hands on assessments and diagnostic tools with pt. hx to reach a conclusion.
> For those that do not like it, different strokes for different folks but its far from malfeasance, negligent or "appalling" Its a tool that can be used.


 
You haven't even finished what is required of you to be a Paramedic in OR yet which I also find appalling that a state which lays claim to requiring a 2 year degree when it actually doesn't. You are young and once you injure a few patients because you fail to understand what it is that you are doing, hopefully you can return to your EMT-B status permanently. Doing something "just because" or "that is how it has always been done" just shows how far you still have to go with your education. If you can not understand why something like the arm drop is harmful, I seriously wouldn't want you around medications especially narcan. This thread has probably given you way too many ideas of how you can abuse or torture the patients you don't like.


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## JPINFV (Feb 1, 2010)

emt_angel25 said:


> ok unless you count the "hand drop" a cruel and unusual punishment on a consious pt. im talkin the big time stuff.



It's ambiguous whether you meant just the hand drop, or the hand drop as an example. However, then if that's all you meant, then ok...


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## EMSLaw (Feb 1, 2010)

I've heard the stories about shoving ammonia inhalents up the noses of OD patients and pinching... but that was back in the 70s.  I'd have thought that after 35-40 years, EMS would have advanced.  

I won't play holier than thou - I've had patients go beyond testing the limits of my empathy.  But ultimately, we're supposed to be there to help, not cause further injury if we can help it.


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## Aidey (Feb 1, 2010)

Honestly, it's hard to get really worked up about ammonia and the hand drop when there are ER docs who still use both. Not ammonia up the nose or in a NRB, but ammonia in general. 

Yes, I understand there are complications to both, and I personally can't be around ammonia, so I won't let it be used in my ambulance. However, I can't condemn another paramedic for doing them when the medical community can't make up it's mind one way or the other.


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## VentMedic (Feb 1, 2010)

Aidey said:


> However, I can't condemn another paramedic for doing them when the medical community can't make up it's mind one way or the other.


 
There are also some ambulances that carry the MAST because their medical director still has faith in it. 

Actually some states have made up their mind about ammonia snaps. NY is one that no longer allows them. Canada also does not allow them throughout much of the country.

While in some controlled environments, it may be acceptable. However for a medical director to accept responsibility with some procedures that have been identified as a high potential for harm and/or abuse for EMT(P)s that include some of the attitudes that are displayed just on a few EMS forums, they would be a fool.   

Those that are agruing the strongest for their right to do something and denying any chance of harm can be done to a patient would be the ones that should not be doing that procedure.  One should know that every procedure done has the potential to do harm as well as be of benefit.  If the complications, side effects and potential consequences are not taught along with the benefits of a procedure, then that instructor has failed at his/her job.


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## rescue99 (Feb 1, 2010)

Aidey said:


> Honestly, it's hard to get really worked up about ammonia and the hand drop when there are ER docs who still use both. Not ammonia up the nose or in a NRB, but ammonia in general.
> 
> Yes, I understand there are complications to both, and I personally can't be around ammonia, so I won't let it be used in my ambulance. However, I can't condemn another paramedic for doing them when the medical community can't make up it's mind one way or the other.



A patient's death is why ammonia inhalents are banned here.


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## mississippimedic (Feb 1, 2010)

I am new here and this topic may not be the best choice for me to comment on as I am sure that I may make a bad first impression.  I use A caps and the arm drift. I not saying that I will never have a negative outcome but I have not yet.  I will also tell people that I believe are faking seizures to hold that arm still so I can start the IV.  Sure is funny watching people seize all over for except their arm that I'm starting the IV in.


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## Veneficus (Feb 1, 2010)

*Without passion or prejudice.*

I am not condoning “torturing” patients. Nor am I holier than any other healthcare provider. But today a colleague and I were discussing an article he read about medical students on Medscape. I didn’t read it myself, but he relayed to me that most medical students lose their compassion for patients around the 3-4th year of school. (Which in the US is the start of their clinical)

So with his background in psych and mine in anthropology, we figured we would discuss why. We came to the conclusion that it has to do with being the subject of abuse. Similar to a child in an abusive family, there is the stress placed on the student from preceptors, hospital staff, patients, and oneself. (Sometimes in the guise of “paying your dues.”)

Eventually people will respond to provocation, it is simply a matter of reaching the threshold. 

I have seen the same in all types of providers. I have even reached the threshold on occasion myself. Just like the difference between palliative pharmacological therapy and euthanasia, the line in the sand is intent. There is a difference between performing medical treatments that are indicated without compassion or taking the most medically expedient path to reach the diagnostic or treatment goals and torture. 

It takes a lot out of people (especially in high volume areas both EMS and in hospital) to constantly give of themselves. On any given day being called names, having a full urinal thrown at you, and any number of forms of abuse by patients only adds to the drain a provider feels. Long hours and little recognition or high demands can also cause a person to reach their threshold sooner.  Compassion gives way to medical necessity, and as we all know, medicine can be downright scary to behold, especially without compassion.  I don’t think providing needed medical treatment can be deemed “torture” even if there are “nicer” ways of doing things. There is a difference between lack of compassion and malice.  

I have even seen resource management dictate care.

I once saw a combative teenage psych patient brought to the ED by her mother. (A lawyer no less) She was so frustrated by her daughter she announced to the staff. "I'll sign any paper you want, do whatever you have to." It makes me think if a mother could reach such a point with her own child, any given healthcare provider could reach such a point of frustration and lack of empathy or compassion with a patient. 

Humiliating a patient and providing unjustifiable procedures most likely would qualify as inappropriate. But there may also be a justifiable interventions performed while being sarcastic or cold. It is always interesting to me to see an outsider’s or new provider’s perspective of medicine.

A quick perspective on IV starts and sizes. Does a larger needle provoke more nociceptive pain than a smaller one? Would it not be dependent on  the quantity of regional pain receptors? Does a larger bore or length needle have more of a psychological response than a painful one? Is it dependant on conditioning? To put it to the test, when I go to the hospital today I will take the “Pepsi challenge.” I’ll have a classmate start an IV with an 18G and then with a 14G without knowing which is which. While N=1 is not a large sample, it may provide some insight without having to get permission from an ethics board for a pain test.


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## Seaglass (Feb 1, 2010)

I don't like punitive medicine. Sure, it bothers me when a patient's faking it, but I'm not the type to start hurting them. Although I do get a lot of satisfaction from the ones who will hold an arm still when asked while "seizing," or the guy who responds to reports of "pt is supposedly unresponsive, but here's what I see" by waking up and yelling "I'm not faking!" 

I have a few coworkers who get pretty nasty with any and all 'unresponsive' patients. Even their first 'trap pinches' will leave a large bruise. If I'm on with them, I'll usually try to be the one assessing responsiveness, for obvious reasons. Doesn't always work. 

The worst I've heard yet is one partner's account of when he got a spousal abuser. (And yes, PD was involved, etc.) After seeing the victim, who was transported by another crew, my partner decided he'd do all kinds of stuff... giant IVs, eyebrow tape, "responsiveness tests," and so on. Apparently the receiving hospital turned a blind eye. I wasn't there, so I don't know what really happened, but it wouldn't surprise me if it's a true story.



Veneficus said:


> To put it to the test, when I go to the hospital today I will take the “Pepsi challenge.” I’ll have a classmate start an IV with an 18G and then with a 14G without knowing which is which. While N=1 is not a large sample, it may provide some insight without having to get permission from an ethics board for a pain test.



I'm very curious to see how this will go. 

Personally, I've noticed that needle size doesn't matter, but repetition does. The first stick doesn't hurt much, but it becomes progressively worse for me if repeated. Repeated shots also hurt a lot worse than repeated sticks, and what's in the shot makes a difference. But I have some medical history that generally makes my nociception a little screwy, so I'm kinda doubtful about whether I'm a representative case.


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## CAOX3 (Feb 1, 2010)

double post


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## CAOX3 (Feb 1, 2010)

Seaglass said:


> The worst I've heard yet is one partner's account of when he got a spousal abuser. (And yes, PD was involved, etc.) After seeing the victim, who was transported by another crew, my partner decided he'd do all kinds of stuff... giant IVs, eyebrow tape, "responsiveness tests," and so on. Apparently the receiving hospital turned a blind eye. I wasn't there, so I don't know what really happened, but it wouldn't surprise me if it's a true story.



If this is true.

No place for this in EMS.  We are not judge and jury, this provider should be shown the door.


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## ExpatMedic0 (Feb 1, 2010)

VentMedic said:


> you haven't even finished what is required of you to be a Paramedic in OR yet which I also find appalling that a state which lays claim to requiring a 2 year degree when it actually doesn't. You are young and once you injure a few patients because you fail to understand what it is that you are doing, hopefully you can return to your EMT-B status permanently. Doing something "just because" or "that is how it has always been done" just shows how far you still have to go with your education. If you can not understand why something like the arm drop is harmful, I seriously wouldn't want you around medications especially narcan. This thread has probably given you way too many ideas of how you can abuse or torture the patients you don't like.



First off everyone on this forum who has stated they use the hand drift test (including paramedics of 20+ years) all have reported no problems with it. Are you saying your better or smarter than them? The hand drift is not appalling or out dated its a matter of opinion. 
With all do respect you are not always right and you need to get it over it. I hate to flatter you or encourage you at all and I am sure it will backfire on me, But I do find a lot of what you say on this forum interesting and informative in many ways. You seem like a very intelligent person and probably a good medic when it comes to patient care. But if your bedside manner and way that you interact with your EMS coworkers is anything at all like on this forum,  I feel for them.


2nd off I was an EMT for almost 6 years and a paramedic for 2, its does not matter what states I am licensed/certified in as Paramedic I hold certification in multiple states. Just because I am going back to college to complete a degree to better myself and my career does not make me new to EMS. 

But whats "appalling" to me is your personal attacks, always trying to get the last word in, and extreme stubborn attitude. What you think of my states EMS system, and me has nothing to do with our topic.
YOU need to respect other people's opinions and you are not an M.D. you work under one, just like the rest of us. It quite apparent to me why you have been banned from this forum in this past.

with all that said Ill let you have the last word on this.... It would be a waste of time to argue with you and just end up getting this topic locked for all the others who are using it.


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## VentMedic (Feb 1, 2010)

schulz said:


> First off *everyone* on this forum who has stated they use the hand drift test (including paramedics of 20+ years) all have reported no problems with it.


 
Everyone? Go back and read the posts again. You just don't want to listen to reason and you seem to not have enough A&P to understand what damage the arm drop test will do. 

You are assuming all the patients you drop their arm across their face will be conscious and pull back. Thus, you are  injuring the patients who need your help the most.

Again, if your instructors did not give you the complications and consequences for the procedures they taught you, they have failed you. I seriously hope they do better with the medication section.

When you are abusive to a patient or can cause them harm, do not expect me to respect you in any way or to condone your behavior. I would rather advocate for your license to be removed so the rest of the EMS providers (or the patients) do not have to suffer a black eye for your actions.


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## 46Young (Feb 1, 2010)

I much prefer to twist the skin on the inside of the upper arm to test responsiveness rather than the arm drift or sternal rub, if more gentle maneuvers prove unsuccessful. No one would expect that, and it can be quite painful if applied with enough force. This is to be used as a genuine last resort to test for a painful response, not as punitive Tx.

I've witnessed some abhorrent behavior during my EMS travels, I'm suprised no one has mentioned these yet:

Drunk tossing - set up the cot at a pre determined distance, one EMT grabs the pt's arms, the other grabs the legs, and 1,2,3, heave ho! 

Piggybacking lasix on the pt, to make them urinate on themselves while extended in triage. Good systems either use a pyxis, or other methods of med accountability to prevent illicit use, either on the pt or themselves. Thank goodness for that. I've seen some get fired for swiping benadryl, lasix, and high dose epi among others for personal use. How many knuckleheads have you witnessed bragging about starting a line on themselves, running in a liter or two, some D50 O2 and thiamine to relieve a hangover?

One crew bragged about carrying around extra 18G's to practice getting sticks on drunks' fingers. Whether they needed a line or not.

Securing someone well to a LSB, and then driving at high speed down a bumpy, pot hole strewn city street (Jamaica Ave in the mid to upper 100's) to cause pain, fear, and discomfort for the "allstate-itis" pt.

How about purposefully letting your pt get soaked in a rainstorm (when it was preventable) because they called for "BS" at 0300?

Anyone who withholds pain meds from a pt when indicated, due to the inconvenience of documentation, restock, QA/QI review and such.


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## Seaglass (Feb 2, 2010)

Newbie question: is the hand drift test the same as the hand drop? I know the hand drift test as part of stroke assessment, where you have the pt close their eyes and raise their arms... I'm not aware of that being noxious... 



			
				46Young said:
			
		

> Drunk tossing - set up the cot at a pre determined distance, one EMT grabs the pt's arms, the other grabs the legs, and 1,2,3, heave ho!
> 
> Piggybacking lasix on the pt, to make them urinate on themselves while extended in triage. Good systems either use a pyxis, or other methods of med accountability to prevent illicit use, either on the pt or themselves. Thank goodness for that. I've seen some get fired for swiping benadryl, lasix, and high dose epi among others for personal use. How many knuckleheads have you witnessed bragging about starting a line on themselves, running in a liter or two, some D50 O2 and thiamine to relieve a hangover?
> 
> ...



Sheesh. I thought some folks at my department were bad. But I've never heard anyone brag about most on that checklist. Only the self-medication for hangover (which I've never actually seen), and the withholding of pain meds (which is usually done out of the misguided idea that it's in the patient's best interest). 



CAOX3 said:


> If this is true.
> 
> No place for this in EMS.  We are not judge and jury, this provider should be shown the door.



If it's true. Like I said, I wasn't there, and I'm not his supervisor or in any position at all to pass judgment. Can't imagine it would be an easy call if I were, either. He's not one of the usual jerks. I've run with him on some calls that were pretty frustrating, and I've never once seen him employ punitive measures. The armchair shrink in me has suspected before that he told me that story because he regrets it.


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## 46Young (Feb 2, 2010)

Seaglass said:


> Newbie question: is the hand drift test the same as the hand drop? I know the hand drift test as part of stroke assessment, where you have the pt close their eyes and raise their arms... I'm not aware of that being noxious...
> 
> 
> 
> ...



That's NYC for ya. Plenty of mutants out in the field along with the professional providers.


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## EMSLaw (Feb 2, 2010)

46Young said:


> How many knuckleheads have you witnessed bragging about starting a line on themselves, running in a liter or two, some D50 O2 and thiamine to relieve a hangover?



In the hierarchy of idiocy discussed in this thread, sucking down some high-flow O2 post hangover probably doesn't even make a blip on the screen.  One of the upsides of being a basic is that your partners can't do anything too stupid to themselves.


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## WolfmanHarris (Feb 2, 2010)

So wait, if I'm following this correctly the "arm drop" is not only practised by some providers here, but has been taught in class? That suggests one of two scenarios, that published textbooks are teaching this (dubious), or instructors with no more education then their students and years of experience built on deficient theory are passing on bad if not potentially injuring habits on as standard. I find the second one more likely. I already see this when I teach Lifeguards and FR's when past instructors have taken their way of doing things and made it the standard.

Allowing your frustration with patients to be taken out on them in any physically or mentally abusive way is a slippery slope. So today you're putting leads on a drunk's head, maybe tomorrow you decide to smack one upside the head yourself. You're supposed to be the one who brings calm to the situation. Sure I transport a-holes and idiots same as everyone else: but the most change you'll see in me is a less sunny demeanor and a firm, no-nonsense tone. My job pays me very well and I enjoy it. I'm not going to throw it away by letting my emotions control me. But more importantly, I'm a professional. 

And if you (the proverbial "you") can't act like a professional, than please, get out of my profession.


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## VentMedic (Feb 2, 2010)

WolfmanHarris said:


> That suggests one of two scenarios, that published textbooks are teaching this (dubious), or instructors with no more education then their students and years of experience built on deficient theory are passing on bad if not potentially injuring habits on as standard. I find the second one more likely. I already see this when I teach Lifeguards and FR's when past instructors have taken their way of doing things and made it the standard.


 
I just checked a couple of textbooks including Brady and found these listed as *appropriate* painful stimuli to test for responsiveness:

sternal rub
pressure to arch above the eye
pressure to the fingernail bed
pinching the earlobe or shoulder skin
squeezing the muscle as the base of the neck

There was no mention of arm drop and as I remember it when I was first heard about doing this many years ago, it was a "trick of the trade" and not something that was ever put in print or "acceptable" for documentation.  However, you may have to admit to it if you do damage or lie and include the injuries as part of your "found with" assessment.


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## Veneficus (Feb 2, 2010)

*n=2*



Seaglass said:


> I'm very curious to see how this will go.
> 
> Personally, I've noticed that needle size doesn't matter, but repetition does. The first stick doesn't hurt much, but it becomes progressively worse for me if repeated. Repeated shots also hurt a lot worse than repeated sticks, and what's in the shot makes a difference. But I have some medical history that generally makes my nociception a little screwy, so I'm kinda doubtful about whether I'm a representative case.



So today I carried out my "study" on the subjective pain levels between insertion of a 14g and an 18g IV catheter. My partner in crime (he didn't consent to be called "lovely assistant") even volunteered himself to increase the sample size 100%. (same morbid curiosity too)

I guess I should disclaim up front that this is a highly biased experiment with a very small sample size and is more meant to satisfy my curiosity, not to determine best practice.  The subjects participating are probably certifiably insane, know enough to be imminently dangerous to the lives and health of others, have really good insurance, and unlimited access to professionals who impart their twisted ways on us and find it just as entertaining. In short, we are "experts." (scary thought) Do not try this at home.

I do not have veins in my hands that would accommodate a 14g catheter. So I had to offer up my median cubital veins. 

I could feel the difference between the insertion of the 14 vs. the 18. I would not say it really caused more distress as the pain difference was rather minimal.

As my friend is not as initiated to the medical world, he was more apprehensive to start. He also stated he was considerably worried about how much the 14 would hurt having just seen and inserted one for the first time. (looks like a sword doesn’t it?) Anyway he was tense and offered that he expected it to hurt more than it did.  He also mentioned that had he not seen the needle prior, he probably would not have known there was a difference between the sizes and the 14 insertion was just the level of pain to expect when somebody was inserting a piece of stainless steel of any size into his body.

There you have it, pseudoscience at its finest. B)

Now if only I can find one of those implanted contraceptive needles. (I swear it must be an 8 guage at least) 

Maybe I could get a spot on "myth busters" and get paid to play around.


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## firetender (Feb 2, 2010)

Vene, my Brother, you miss the point (pun intended), though you did one fine job of getting the point, but you did so for no damn good reason: *Size Doesn't Matter!*

The Medic who thinks they are instilling more pain by the size of the needle is not really serious about inflicting damage to their patient. The ones who are dangerous are the ones who brandish the 12 gauges in delight; using threat as torture and then making sure they follow through...slowly! Unfortunately, there are such people in the back of ambulances.

I do NOT condone such things; just a reflection of what I've seen.


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## Veneficus (Feb 2, 2010)

firetender said:


> Vene, my Brother, you miss the point (pun intended), though you did one fine job of getting the point, but you did so for no damn good reason: *Size Doesn't Matter!*.



That's just something they tell the little guys 

Really though, I always wondered if there was more of a psychological impact of being stabbed with a needle than actual physical pain. (I don't routinely get stabbed or cut to know) In that respect, I think we discovered that there is significant psychological impact. Even if our method was flawed.

Sometimes time passes slowly, and the time can be made more interesting with stuff like that I guess.

Besides, nephrology clinicals are dreadfully boring usually. Sometimes something goes horribly wrong for somebody and the game is on. (Like last week) but usually it is an excercise in staying awake or not losing your vision reading lab values.  




firetender said:


> The Medic who thinks they are instilling more pain by the size of the needle is not really serious about inflicting damage to their patient. The ones who are dangerous are the ones who brandish the 12 gauges in delight; using threat as torture and then making sure they follow through...slowly! Unfortunately, there are such people in the back of ambulances.
> 
> I do NOT condone such things; just a reflection of what I've seen.



Being soley planted in Myers-Briggs ENFJ category, I agree, if you must resort to physical torture, you are not very good at it. 

Nobody would give me a 12g or 10g outside of theatre  I do so like procedures.


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## Seaglass (Feb 2, 2010)

VentMedic said:


> I just checked a couple of textbooks including Brady and found these listed as *appropriate* painful stimuli to test for responsiveness:
> 
> sternal rub
> pressure to arch above the eye
> ...



If someone writes it up in a PCR, I'd take it as a sign that they really don't know better.

I first learned about the arm drop as a test for conversion disorder or catatonia. It is used clinically, but rarely (both of those are rare to start with), and for actual diagnostic purposes, as opposed to determining who's faking and who's not.


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## mississippimedic (Feb 2, 2010)

Yeah it's scary sometimes what people don't know what to document or more importantly, what in the world they are doing. I know of a guy that pushed    90mg of dopamine and then documented it.


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## reaper (Feb 2, 2010)

If he pushed 90mg of Dopamine, I would sure hope he documented it! Anything else is fraud and lying.


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## mississippimedic (Feb 3, 2010)

you are correct, it would be fraud and lying, I was using that as an example to the previous post.


If someone writes it up in a PCR, I'd take it as a sign that they really don't know better


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## lightsandsirens5 (Feb 3, 2010)

Holy cow! I just read through this thread for the first time and I have to admit, I must be pretty naive (spelling?). I have not even heard of many of those practices going on. Most of them are felony assult and battery are they not? Stabbing a pt with a needle? Stuffing alcohol wipes up their nose? Pinching them hard enough to leave a good bruise? We are out there to help them, not hurt them, right?

And at my service, we are not allowed to use things like sternal rubs, arm drops, inhalents (spelling? again), etc. I did not know that other places were still doing this kind of stuff.


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## CAOX3 (Feb 3, 2010)

Sternal rub is an accepted method of measuring LOC.

As with anything it can be taking to the extreme and the results can be dangerous.

If your leaving marks on patients trying to determine LOC then your doing something wrong.

If you cant control your emotions and feel you need to dish out some kind of punishment then EMS probably isnt for you, its raw and uncut.(and I think thats a tagline for something but I just stole it.  )


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## 46Young (Feb 3, 2010)

lightsandsirens5 said:


> Holy cow! I just read through this thread for the first time and I have to admit, I must be pretty naive (spelling?). I have not even heard of many of those practices going on. Most of them are felony assult and battery are they not? Stabbing a pt with a needle? Stuffing alcohol wipes up their nose? Pinching them hard enough to leave a good bruise? We are out there to help them, not hurt them, right?
> 
> And at my service, we are not allowed to use things like sternal rubs, arm drops, inhalents (spelling? again), etc. I did not know that other places were still doing this kind of stuff.



EMS seems to attract all types of mutants. Good news is, if you're a medic you can see to it that none of this nonsense goes on with your pts.


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## lightsandsirens5 (Feb 3, 2010)

CAOX3 said:


> Sternal rub is an accepted method of measuring LOC.
> 
> As with anything it can be taking to the extreme and the results can be dangerous.


 
I think that is why out MPD nixed it....I'll have to ask him.


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## Seaglass (Feb 3, 2010)

46Young said:


> EMS seems to attract all types of mutants. Good news is, if you're a medic you can see to it that none of this nonsense goes on with your pts.



All the more reason why I'd like to become one sooner rather than later. When I get stuck with medic partners like that, there's often very little that I can do to stop it.

(Not that I don't try. I do.)


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## CAOX3 (Feb 3, 2010)

Grow the F$#k up dumb$ss, you look like an idiot usually works for me.*

*Works for both EMTs and medics.


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## Veneficus (Feb 3, 2010)

lightsandsirens5 said:


> I think that is why out MPD nixed it....I'll have to ask him.



How are you supposed to check for response to painful stimuli without a painful stimuli?

It would eliminate the use of GCS completely.


Even AVPU (which I think should be removed from memory) would not be possible.

That would leave a major gap in the standard of care.


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## mycrofft (Feb 3, 2010)

*OOOOOo, verbal abuse, might cause emotional bruises.*

We were discussing noxious stimuli yesterday, our old doc recommended eighteen gauge IV start with SNS in dorsal hand.

Lift the eyelid without warning. Can be very enlightening


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## EMTinNEPA (Feb 5, 2010)

mississippimedic said:


> Yeah it's scary sometimes what people don't know what to document or more importantly, what in the world they are doing. I know of a guy that pushed    90mg of dopamine and then documented it.



90 MILLIgrams? As in 90,000mcg?

PUSHED? As in, drew it up in a syringe and pushed all at once as a BOLUS?

How many limbs did the patient lose?


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## mississippimedic (Feb 5, 2010)

EMTinNEPA said:


> 90 MILLIgrams? As in 90,000mcg?
> 
> PUSHED? As in, drew it up in a syringe and pushed all at once as a BOLUS?
> 
> How many limbs did the patient lose?



He lost all of them as he died shortly there after.


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## EMTinNEPA (Feb 5, 2010)

mississippimedic said:


> He lost all of them as he died shortly there after.



Please tell me that this "paramedic" got hung out to dry.


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## Veneficus (Feb 5, 2010)

EMTinNEPA said:


> 90 MILLIgrams? As in 90,000mcg?
> 
> PUSHED? As in, drew it up in a syringe and pushed all at once as a BOLUS?
> 
> How many limbs did the patient lose?



how does your dopamine come packaged that you have 90mg to draw?


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## mississippimedic (Feb 5, 2010)

Veneficus said:


> how does your dopamine come packaged that you have 90mg to draw?




400mg/5mL Vials


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## boingo (Feb 5, 2010)

EMTinNEPA said:


> 90 MILLIgrams? As in 90,000mcg?
> 
> PUSHED? As in, drew it up in a syringe and pushed all at once as a BOLUS?
> 
> How many limbs did the patient lose?



90mg = 900mcg.....for a 90 kg pt at 10mcg/kg/min, that would be a dose for 1 minute.


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## EMTinNEPA (Feb 5, 2010)

boingo said:


> 90mg = 900mcg.....for a 90 kg pt at 10mcg/kg/min, that would be a dose for 1 minute.



No, a milligram is equal to 1000 micrograms.

90mg X 1000 = 90,000mcg

90kg patient at a dose of 10mcg/kg/min

90mcg x 10mcg/kg/min = 900mcg/min

How long would it take to give the dosage this "medic" gave at 10mcg/kg/min?

60min in 1hr

90,000mcg divided by 900mcg/min = 100min

100min divided by 60min/hr = 1hr 40min

So in a few seconds, this "medic" gave the patient the same amount as over an hour and a half's worth of medication at the pressor dose.


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## lightsandsirens5 (Feb 5, 2010)

Veneficus said:


> How are you supposed to check for response to painful stimuli without a painful stimuli?
> 
> It would eliminate the use of GCS completely.
> 
> ...


 
We are supposed to pinch the back of their hand or the skin on their arm. 

And I just talked to my SEI, sternal rubs are acceptable, but the MPD highly discourages them.


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## boingo (Feb 5, 2010)

EMTinNEPA said:


> No, a milligram is equal to 1000 micrograms.
> 
> 90mg X 1000 = 90,000mcg
> 
> ...



Yeah, time for a nap....


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## lightsandsirens5 (Feb 5, 2010)

mississippimedic said:


> He lost all of them as he died shortly there after.


 
As a result of the extreme OD? 'Cause if it was, that is Criminally Negligent Homicide with Willful Disregard for Life at the least, strait up Unlawful Manslaughter more likely.


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## 8jimi8 (Feb 5, 2010)

alot of these posts are scary.  


Can we conjecture why providers who have done said actions are still employed in our services?


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## Hal9000 (Feb 5, 2010)

I haven't read every reply in this thread, so forgive me if this has already been mentioned.

I used to sleep on a very hard bed.  One night, I woke up, and my arm was completely numb.  It was dark, but I rolled over and grabbed my hand with my good arm, and sure enough, it was completely "asleep."  Out of curiosity, I lifted it above my face with my good arm to see if I could examine it (it was dark in my room), but I couldn't see it at all. 

Without thinking, I then released my grip on it.  What happened?  It fell straight onto my face and gave me an instant, high-power nosebleed.

I don't think it is advisable to potentially cause this sort of harm to a patient, especially if they're unconscious. 





VentMedic said:


> The human arm is actually quite heavy in an unconscious patient and if you ever had to restrain it to keep from falling off the stretcher, you would know this.  Also, the patient might be wearing a bulky watch, bracelet or rings that can do even more damage.   You are also still a new Paramedic that is still completing your education so consider yourself very lucky that you have not injured a patient yet.
> 
> Dropping the arm across the face is like doing the witch in the deep lake test.  If the person lives, they are a witch.  If they are innocent, they drown.  Thus, if the patient is faking being unconscious, they pull the blow away from their face.  If they are actually unconscious, they may be injured.
> 
> Keep doing this practice and I can guarantee you will eventually have to answer for your actions.  Your medical director may also not be so quick to back you up unless he/she is stupid enough to put it in writing as an acceptable protocol.   Of course when something adverse does happen, it wouldn't be too difficult to get an expert witness like Dr. B. Bledsoe who has written several articles on the subject or someone with similar qualifications.


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## Veneficus (Feb 5, 2010)

mississippimedic said:


> 400mg/5mL Vials



so are you getting the prefilled bags now?


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## mississippimedic (Feb 5, 2010)

Veneficus said:


> so are you getting the prefilled bags now?




I doubt it, this happened about 2 yrs ago.  I'm no longer with that service


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## 46Young (Feb 5, 2010)

boingo said:


> Yeah, time for a nap....



Reference cards tailored to your protocols for dose calcs would be a good idea. No one's at their best at 0300 hours. For dopa, it's easy. Mix 200 in a 250 bag, and to run at 10mcg/kg/min all you need to do is multiply the pt's weight in kg's by .75 (75%) and you have your drip rate. Try it the long way, it's 100% accurate, not just a ballpark figure.

For example, at that concentration, the 100kg pt gets 75gtts/min, the 80kg pt gets 60gtts/min, the 60 kg pt gets 45gtts/min. It's equally accurate for odd weights , such as 53, 77, 92 or whatever.


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