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Thank you, I will indeed =]
Appendectomy for Paramedics
- Thread starter medic417
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Thank you, I will indeed =]
TatuICU
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medic417
The Truth Provider
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Please lets stay on topic and serious.
mycrofft
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The thread is pseudoserious and overlong.
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medic417
The Truth Provider
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Nope just the right length.
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Twss?
mycrofft
Still crazy but elsewhere
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..."And growing!".
Just for the record my comment was being sarcastic due to the topic of this thread. I could never see ems providers doing surgery with the exception of a needle or surgical cric. Dr's go to school for many years before they are even allowed to hold a knife over a patient.
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medic417
The Truth Provider
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See THIS is what i've been trying to convince folks to do for ages!!
I mean, its not like we in EMS don't have the training or education! and we sure as hell have the money!!
why just limit yourselves to appendectomies? people, this is the age of revolutions in EMS!
I'm thinking we engineer fluoroscopes into the back of our trucks so we can do PCPI in the field,
take the cath lab to the patient!!
12 lead, 15 lead, even 18 lead?
NOPE contrast angiography!! now we're talking!
portable X-rays? the devices are there, they only Cost about 30K!! sping the xray around the patients head and you have a CT brain!, inject them with contrast and you have a CT brain with contrast!
lets start doing stroke CVA fibrinolysis in the field!
bring out the tPa!
actually, screw that, im thinking peri-mortem cesareans. it is a life saving intervention after all! and yes, there was the article about the two paramedics who got fired and sued for doing it under med control, but if were insured, what could go wrong?
im also thinking we let EMT-B's do surgical airways and suturing? i mean, think about it, they arent actually tricky skills? they're just a little bit invasive.
anyway, thats just my 2cents
lets broaden our horizons!
I mean, its not like we in EMS don't have the training or education! and we sure as hell have the money!!
why just limit yourselves to appendectomies? people, this is the age of revolutions in EMS!
I'm thinking we engineer fluoroscopes into the back of our trucks so we can do PCPI in the field,
take the cath lab to the patient!!
12 lead, 15 lead, even 18 lead?
NOPE contrast angiography!! now we're talking!
portable X-rays? the devices are there, they only Cost about 30K!! sping the xray around the patients head and you have a CT brain!, inject them with contrast and you have a CT brain with contrast!
lets start doing stroke CVA fibrinolysis in the field!
bring out the tPa!
actually, screw that, im thinking peri-mortem cesareans. it is a life saving intervention after all! and yes, there was the article about the two paramedics who got fired and sued for doing it under med control, but if were insured, what could go wrong?
im also thinking we let EMT-B's do surgical airways and suturing? i mean, think about it, they arent actually tricky skills? they're just a little bit invasive.
anyway, thats just my 2cents
lets broaden our horizons!
Obstructions
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Why would there be a need for an emergent appendectomy? You'd run out of time in order to finish the procedure. It'd just be faster to go the hospital and have a physician, who has had 8+ years of training, complete the procedure. How would you keep your field sterile? What about all the liability and malpractice crap about anesthesia and surgeries? Can you really finish this surgical procedure with just you and a partner? Plus I'd be scared as hell if people like me who still don't really know what there doing were cutting into me and taking a part of my body.
NYMedic828
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The entire thread is a joke... fyi.
VFlutter
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If medics get appendectomies then I should be able to intubate. Only fair 
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If medics get appendectomies then I should be able to intubate. Only fair
So once you get your CRNA/ACNP, does that mean we get fair game on abdominal surgeries?
VFlutter
Flight Nurse
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So once you get your CRNA/ACNP, does that mean we get fair game on abdominal surgeries?
Sure. We can put a Davinci on every ambulance
NYMedic828
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Sure. We can put a Davinci on every ambulance
That is officially one of the coolest things I have ever seen. (just youtubed it)
here in hungary, perimortem c-sections are in the medic scope after someone performed a successful(and widely publicised) one on a gravida in traumatic arrest
mycrofft
Still crazy but elsewhere
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THIS reply is worth resurrecting the discussion:
ANYTIME a doc tells you something like that, no matter how empowering it may sound, get it in writing through the formal protocol process. I've watched instances where MD's said "I'll cover you if you...", or "I am making a standing "(verbal)" order to do this...", or they send out an email or xeroxed written order on their own authority setting protocol, as it were. When you kill someone or it goes to court because they can't see, or have babies, or feed themselves anymore, where's that doc going to be?
No, that's not the Medical Director's Tribal Council hut.
(red letters are my emphasis).Lol! I actually just got out of our week-long CME class this week. Our medical director and our area trauma guru both told us that if we have a patient requiring one, they fully expect us to perform it...
ANYTIME a doc tells you something like that, no matter how empowering it may sound, get it in writing through the formal protocol process. I've watched instances where MD's said "I'll cover you if you...", or "I am making a standing "(verbal)" order to do this...", or they send out an email or xeroxed written order on their own authority setting protocol, as it were. When you kill someone or it goes to court because they can't see, or have babies, or feed themselves anymore, where's that doc going to be?
No, that's not the Medical Director's Tribal Council hut.
I wouldn't even accept that.
History:
Back in the days of wooden ships and iron men, when i first started, our state scope was "anything the doctor told you to do." I thought that was really cool. I even got really angry when the state changed med directors and the new one started to significantly restrict what paramedics could do.
That was the first time I was told there is no EMT-Vene cert. That whil I could be trusted to do some crazy stuff, (actually the hallmark of my career) not everyone possesses the same ability. That is probably when I realized EMS just wasn't big enough.
Now:
A few years down the road, I have actually been trained in many things I was asked to do without training. I have learned what can go wrong. I have also learned the most important suffix in medicine. "Oid" meaning: looks like but isn't. (along with what it really is)
recently I had to argue with a nurse who questioned whether or not I knew what I was doing because it conflicted with her routine. As it turned out, she was under the impression that anaphylaxis caused by IV meds works like transfusion reactions and if you stop the infusion, you stop the progression of anaphylaxis. (Absolutely not the case) If it were, removing the insulting agent would stop all anaphylactic reactions, which we all know doesn't happen.
That illustrates very well why providers need all of that "book learnin."
As most nurses can attest, when something goes wrong, doctors are going to point to somebody else. Especially if there is no record. But one of the most terrifying questions I can think of to have to answer on a witness stand when you already know the answer is "no" is:
"Can you provide documentation that you were trained how to properly perform that procedure?"
If you are not formally taught how to do something with documentation, my advice is don't.
For those unknowing, if a paramedic instructor teaches you something outside of your scope of practice and you actually do it. They can be held legally responsible.
Just because a doctor tells you how to do something does not equal being taught.
The best piece of advice I have for any provider is: Always think about what happens next.
I sat in an ATLS class once where the instructor told us an anecdote about an emergency physician that performed a thoracotomy at rural hospital and then asked if the level 1 could fly a surgical team out to close the pt. (which logistically is not feasable, hospital privilidges, insurance coverage, even knowing where to find supplies)
His advice: If you can't close it, don't open it.
Comes into play with "what next?"