Almost!

[VentMedic]

Surgery was a success and the pt is expected to make a full recovery.

In the haste of my last post I failed to mention the whole situation. Including how my medic figured it to be a esoph v. ( which it was ).

Surgery? If it was esophageal varices, do you mean endoscopic banding?

A full recovery with esophageal varices? Hardly. Even with banding that only buys them a little time if portal hypertension is the cause.

Yeah we're all ears. Did you forget the cirrhosis part? Tylenol? I hope that was noted in the ED by your Paramedic?

And, what tx did your Paramedic provide?

This is a good case so please provide more information or get your medic to discuss it.

 

[EMT.Hart]

Well, we are all ears.

Haha. I'd be more than happy to oblige if what you asked didn't include typing a full run sheet on an iPhone. (big fingers. Little buttons)

 

[mycrofft]

Esophageal varices....nope never saw the Paramedic curriculum.

What "I" did or didn't do is sorta irrelevant unles this is about personalities. I never read the material in the paramedic book because I went from EMT-A and crash rescueman to RN without doing paramedic as I originally intended. I got my ACLS afterward.

In 22 plus years I've had to contend with four real life cases, no, patients, with esophageal varices, and within two years #2 was dead (#3 and #1 died within 24 hrs of presenting , and #4 didn't make it off the campus).

The local trauma center/teaching hospital put it this way...if those cases had occurred in their ER, the likelihood of survival over any meaningful length of time was still next to nil, because there is simply no way to stop such massive sudden blood loss. Just as well push a 12 ga to their chest and pull the trigger.

In the real world, in the field, the time to take to do a ddx on a rupturing esoph varix versus other worsening sources of lots of blood from down the throat is just time dithering; you HAVE no measure to benefit the pt and youjr diagnostics for that arena are inferior. Big bore bilateral lines, airway, work on your differential while getting to the echelon of care your patient will require no matter what the diff is. Be sure to pass on what measures you have taken. You will probably go down swinging, but those are your patient's only chances.

Cut to the chase.

 

[mycrofft]

Oh, and I'm not a troll.

Ogre maybe....

 

[mycrofft]

Hey, blew a varix on my lower leg today!

Tiny scab, scratched it:blush:, and a 2 mm opening was revealed rapidly welling dark, almost black blood, lost about 20 cc before I got it stopped. And THAT was a very exposed spot (anterior lower leg between tib and fib) and I was in a medical faciity.
Down the esoph or up the large bowel...good luck, its dark in there.

 

[allvitals09]

I have been an EMT for about 6 months and a paid one for just over a month.
... I work at a private ambulance service and have done many "emergency" transports. But today we just got back from a call and here's how it went.

Got called out to a nursing home where an elderly female chocked on a Tylenol pill just over an hour prior to ems arrival. Pt had acid reflux hx and was spitting up " dark maroon blood ". My medic had ruled that it was an esophogeal varesice( spelling? ). Any rate. The obviously went into compensative shock.

As we rolled up into er and dropped the pt on the er bed she crashed. Er called code and pushed us out of the way.

Now... Don't get me wrong. I'm glad we got her to the hospital on time but if the nursing home would have waited 6 more minutes. I would have been able to run my first code 3!

- hope she does well.

Thread question. -- what was your first code 3 like? --

Yay for patient advocacy.

 

[dragonjbynight]

There is something about the lights and sirens that make people drive like complete idiots. First time you light it up you will see what everyone does... the lights make the other drivers nervous or something.

couldn't say it better myself. People like to slam the brakes directly in front of you. Pull out from that intersection faster....do some of the most insane stunts you'll ever see when they see L&S.....No thanks.

I would much rather transport no L&S 90% of the time.

 

[VentMedic]

couldn't say it better myself. People like to slam the brakes directly in front of you. Pull out from that intersection faster....do some of the most insane stunts you'll ever see when they see L&S.....No thanks.

I would much rather transport no L&S 90% of the time.

You can't just blame the general public. There are too many in EMS who have poor EVOC training.

They over drive their sirens with excessive speed.
They come up too quickly on the bumper of a car and expect them to move immediately and that could be right into harms' way.
They display impatience and do erratic movements from lane to lane, not knowing even what lane would be the best.
They are not familiar with the streets in their area.
They do the bumper tap and nudge if a car does not move out of their way quick enough.
They blast and honk even when they know there is nowhere for the traffic to go immediately.
They drive distracted with iPODs to where they may not hear a warning from their partner and while text messaging.
They fail to come acknowledge stop signs and red lights.
Some are driving under the influence of drugs and alcohol while behind the steering wheel of an emergency vehicle.
Too many are driving tired from 24 and 48 hour shifts.

 

[VentMedic]

I forgot to mention very young and inexperienced drivers being allowed to drive a large emergency vehicle. Some may have held a driver's license for only a few months and may not have even a 1000 road miles to their experience.

 

[exodus]

I forgot to mention very young and inexperienced drivers being allowed to drive a large emergency vehicle. Some may have held a driver's license for only a few months and may not have even a 1000 road miles to their experience.

You can't just blame the general public. There are too many in EMS who have poor EVOC training.

They over drive their sirens with excessive speed.
They come up too quickly on the bumper of a car and expect them to move immediately and that could be right into harms' way.
They display impatience and do erratic movements from lane to lane, not knowing even what lane would be the best.
They are not familiar with the streets in their area.
They do the bumper tap and nudge if a car does not move out of their way quick enough.
They blast and honk even when they know there is nowhere for the traffic to go immediately.
They drive distracted with iPODs to where they may not hear a warning from their partner and while text messaging.
They fail to come acknowledge stop signs and red lights.
Some are driving under the influence of drugs and alcohol while behind the steering wheel of an emergency vehicle.
Too many are driving tired from 24 and 48 hour shifts.

I don't know of very many high and drunk EMT's/Medics on the job.... And I doubt a company would let an 18 year old with a license only 3 months old driver an ambulance... And hell! I drive over 1,000 a week just on the job!!!

 

[VentMedic]

I don't know of very many high and drunk EMT's/Medics on the job.... And I doubt a company would let an 18 year old with a license only 3 months old driver an ambulance... And hell! I drive over 1,000 a week just on the job!!!

Just look at the MVCs involving ambulances that have made the EMS news wires and have been discussed on the forums. You can not imagine how many that have not been picked up by these news wires.

The reason some unsafe drivers or impaired drivers are allowed on the road is because their partners put blinders on and don't want to be a snitch or think their partner's drug and alcohol problem is just "recreational" or their own business...until they hurt you and then it is often too late.