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  1. zmedic

    Confused

    The reason BP drops in pulses paradoxes is that when you increase venous return to the heart, like during inspiration, the right ventricle fills more, and you get bowing of the septum, which can occlude the aortic outflow tract. Normal doesn't have much of an effect but when you have a condition...
  2. zmedic

    humeral head IO

    Remember that flow varies with the 4th power of the lumen, but also inversely with the length. Most triple lumens are like 20cm. So even if the triple or double lumen is only a little smaller than an IV, they flow much more slowly than a short peripheral IV. (They are great for critical care...
  3. zmedic

    Thermometers

    I think it would depend on what is already in place and (obviously) protocols. If you were working a marathon in August, they brought a guy to the first aid tent who looks like he is suffering heat stroke, and has altered mental status. Now I tell you his temperature is 107 rectally, what do you...
  4. zmedic

    Ankle dislocation + distal fibula fx

    It's harder the longer it goes, but I've had some good results with some prone positioning and scapular manipulation, some hanging with weights. Often these are patients with multiple previous dislocations and are pretty loose. But if it doesn't go easily it's sedation time.
  5. zmedic

    Ankle dislocation + distal fibula fx

    I would have actually taped the pillow around the ankle, otherwise you hit a bump and it would hurt a heck of a lot. Agree that if decreased CSMs you need to pull inline and try to reduce. In the ER i'd reduce it with propofol, after proper analgesia. More so they don't remember it than for...
  6. zmedic

    Can I defibrillate in the rain?

    Is this a song title? Like "tears on my AED" or "keep compressing cutie, as you break my heart."
  7. zmedic

    Hyperglycemia

    I'd also point out that 10 units of insulin isn't all that much. For DKA patients get put on 0.1units/kg/hour drips. So a 80kg person will get 8 units an hour usually for 6-8 hours until their BGLs drop to 250, at which point they get glucose added to their IV fluids (so their glucose doesn't...
  8. zmedic

    Taxpayers paying to defend EMT accused of hitting on patient

    Clearly over the line to contact a patient via facebook and ask for a number. But also a good reminder to everyone that some of those verbal tics/mannerisms can get you in trouble. Generally I would advocate not calling patients "honey, sweetheart, babe, etc." Had a co-worker who used to call...
  9. zmedic

    Ruptured Spleen

    I'd say if someone is bleeding so much from a ruptured spleen that you are starting pressors then it is time to go to the OR. Also I'd wait until the IVC looks like it is full on ultrasound before starting levo, want to make sure they have enough stuff in the pipes before starts pressors.
  10. zmedic

    Ski Patrol/Winter SAR

    Thinking about letting that OEC go. It's sad but for the next year or two I don't think I'm going to be near the mountains, going to be working pretty hard. Hopefully someday I'll get back to the hills.
  11. zmedic

    Whats the fastest you ambulance can go?

    My FluxCapacitor is down, otherwise I'd be out waiting for lightning storms. Gotta go fast and go back for my HoverBoard
  12. zmedic

    When to cut away a patient's clothes?

    I get pissed when my patients aren't undressed because it wastes my time. You are here for a foot problem? If I have to stand there while you take your shoes and socks off it slows me down. Rectal bleeding? People look at me like I'm crazy when I say I have to take a look.
  13. zmedic

    Benefits of being a 68W in a civilian setting?

    You just need to remember there are opportunity costs associated with staying in. Yeah, more military experience might help, but so would getting out, doing a year paramedic program and getting 3 years experience as a medic v spending another 4 years in the military. If you are trying to...
  14. zmedic

    NOLS vs. RMI vs. SOLO

    I did my WEMT with SOLO, loved it. Refreshed with WMI and thought they were good too. I think it's more about who has a class near your that works with the dates you have free. If you live near SOLO, go there. If you are out west, prob more WMI classes.
  15. zmedic

    Omission of spinal precautions

    I guess my problem with this is that you are making decisions for the patient that you are going to treat them differently based on your perception of their quality of life. I'd be fine with you talking to the person who makes decisions for the patient and having them refuse backboarding. But I...
  16. zmedic

    Does it matter if a uniform has a badge or not?

    I back this. I'd rather not have a badge on when I'm working, especially if I was working somewhere that made me wear dark blue shirt and blue or black pants. Makes you look way too much like a cop to a drunk patient. I like having a nice clear line between me that is trying to get a patient to...
  17. zmedic

    HAZMAT course in NY.?

    The issue is that you usually have to be affliliated with a FD to sign up through the fire academy. Though if you are interested in HAZMAT/rescue work it would be worth trying to get on a volunteer company and going through the FF1 class. It's not that long a class if you live near where it is...
  18. zmedic

    Abandonment?

    Searching online it seems that duty to act is needed for malpractice, where abandonment " is the unilateral termination of a provider/patient relationship when the patient still needs care, but provision is not made for that care and an injury results. Refusal to transport a patient or talking...
  19. zmedic

    Abandonment?

    First rule is generally to listen to police officers. You should be sure that the police officer knows that you are an EMT and that you would like to continue patient care until relieved by another EMT. I think you'd be pretty safe in court if you said "I was ordered by a uniformed police...
  20. zmedic

    Pt faking seizure

    I'm a strong believer in benzos (Ativan, Valium) for thing that looks like a seizure. My thinkings is either: 1: They are really having a seizures, and the benzo will help with that. or 2: They are faking, and if they are doing this to the point where I have to deal with them they have a...

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