Give me a differental, please...

[emtfarva]

But, you also stated she already got one bolus of NS. That could explain the BP being "norm" now.

I didn't say anything about heart problems.

Fever
UTI
MS
Tremors

Pending septic work up wihich includes a lactate level. Depending on other lab finding will determine if they do a full sepsis protocol to anticipate complications.



Look at the other symptoms.

In OP that was the first BP I took before a line was even in. also the dr office had the same bp as me 10 min prior to me. (it was close to mine) I know you didn't say anything about cardiac issuses, What I meant could this be something that was masking as the ovious. can't an eptopic present with a fv.

 

[VentMedic]

In OP that was the first BP I took before a line was even in. also the dr office had the same bp as me 10 min prior to me. (it was close to mine)

Your time frame is still just 15 minutes AND she got a bolus of NS. Don't get hung up on "normal vitals". You must assess the whole picture.

I forgot this was a call from the doctor's office. The doctor has already added this up and sees the need for this patient to be hospitalized quickly. If the doctor had suspected etopic pregnancy he would have called that report to the ED personally.

Blood in the urine.
Along with pain in the LLQ
Febrile
Tremors
MS

 

[emtfarva]

What about deffered pn, could it be her gald bladder or diverticulitis (i know that is an infection) what about kidney stones? I hate the abd.

 

[sir.shocksalot]

Incorrect. Read up on the temperature variations found in the different devices. It is more than a question of variation. The difference between one thermometer being used in different orifices is a question of simple variation that can be correlated. But when you use the temporal or tympanic thermometers, there is a serious question of overall accuracy to be considered. They can be off by a medically significant amount.


Again, temperature is part of a complete assessment. Before rendering any treatment, we should be performing a complete assessment to be sure of what we are actually treating. What you are talking about is simply treating symptoms. That is no better than treating the thermometer.


Lecture us about what EMS professionals should do when you are one. The key term in EMS is MEDICAL. And medical professionals don't have the "luxury" of simply treating symptoms by the cookbook because they don't have the education or understanding to interpret the results of the assessment that they should be performing.

This is an example of why it is so much easier to make a good medic out of someone with no EMT experience. We don't have to waste time going back to wash all these silly notions of "we don't need all that book learnin' because I'm just an ambulance driver" out of their heads.

Last time I checked I get paid to treat patients, which makes me a professional. You can tell me how little I know until you are blue in the face, end result is with both are in this business to treat patients. I encourage you to correct me, that way I learn, which is and always will be my lifelong mission. I do not encourage you to belittle myself or any other EMT, we all started as an EMT, and viewing us as nobody's will not land you in any EMT's good graces. Before you assume that I "don't need all that book learnin" I am probably just as well educated, if not more so than you, it might not be in EMS, but I am very well educated, so don't assume I am some Joe Blow who got their EMT to drive an ambulance around. Furthermore, what ever your views of this profession is, reality is that most ambulances DO NOT stock thermometers.

 

[emtfarva]

All I am trying to do here is get some could be's. I get what you are saying about the whole picture. But the VS didn't seem to change at all in the 40 mins that we had into the Pt's picture. yes you are right, the dr did see the need for the Pt to be seen at the hosp as quickly as possible.

 

[AJ Hidell]

I don't think you'll ever see chole pain referred from the RUQ to the LLQ. At least, I have not ever seen that. They generally don't present this acutely either. That said, it is not completely out of the realm of possibility. It can, however, be pretty well ruled out with a thorough exam.

Diverticulitis and nephrolithiasis are both possibilities too. Like a chole, diverticulitis generally also does not present quite as acutely. Certainly not enough to cause chills.

Pyelonephritis, and to a lesser extent, nephrolithiasis would be the two most likely diagnoses, going strictly upon what has been presented here. However, as already outlined, there are a multitude of other possibilities.

Who found the hematuria? And at that time, did they not also dip for pus, bacteria, and nitrites?

 

[sir.shocksalot]

All I am trying to do here is get some could be's. I get what you are saying about the whole picture. But the VS didn't seem to change at all in the 40 mins that we had into the Pt's picture. yes you are right, the dr did see the need for the Pt to be seen at the hosp as quickly as possible.

Did you request a follow up?

 

[VentMedic]

I am probably just as well educated, if not more so than you, it might not be in EMS, but I am very well educated, so don't assume I am some Joe Blow who got their EMT to drive an ambulance around.

I have a Masters degree in a medical science. I know a little bit about flying a helicopter but don't feel qualified to tell my pilot how to do his job.

The key is medical education. Unfortunately, in the U.S. EMT-B is only 110 hours with no prerequisites required. While some of us do know there are others with more education, it is difficult to remember everyone's resume. If your degree is not in medicine you may be well educated but not in medicine.

Taking statements at face value because the is always the way you learned it or has been the practice forever doesn't always make it correct. Thus, the reasons why some of us want to raise the bar on education and patient care standards.

 

[VentMedic]

I don't think you'll ever see chole pain referred from the RUQ to the LLQ. At least, I have not ever seen that. They generally don't present this acutely either. That said, it is not completely out of the realm of possibility. It can, however, be pretty well ruled out with a thorough exam.

Diverticulitis and nephrolithiasis are both possibilities too. Like a chole, diverticulitis generally also does not present quite as acutely. Certainly not enough to cause chills.

Pyelonephritis, and to a lesser extent, nephrolithiasis would be the two most likely diagnoses, going strictly upon what has been presented here. However, as already outlined, there are a multitude of other possibilities.

Who found the hematuria? And at that time, did they not also dip for pus, bacteria, and nitrites?

Lot of itis(s) to rule out or in.

The symptoms in an otherwise healthy person may not be as noticable but with the MS hx, they could be more severe.

 

[emtfarva]

I don't think you'll ever see chole pain referred from the RUQ to the LLQ. At least, I have not ever seen that. They generally don't present this acutely either. That said, it is not completely out of the realm of possibility. It can, however, be pretty well ruled out with a thorough exam.

Diverticulitis and nephrolithiasis are both possibilities too. Like a chole, diverticulitis generally also does not present quite as acutely. Certainly not enough to cause chills.

Pyelonephritis, and to a lesser extent, nephrolithiasis would be the two most likely diagnoses, going strictly upon what has been presented here. However, as already outlined, there are a multitude of other possibilities.

Who found the hematuria? And at that time, did they not also dip for pus, bacteria, and nitrites?

The dr office found the blood. the Pt also stated that she had been spotting, and that she was earily for her period. Now I wonder if she was on birth control? I will have to find that out. I don't think the dr had the capablity to do what you asked me for. I think they were going to let the hosp do that where the lab stays open 24 hrs a day.

 

[VentMedic]

The dr office found the blood. the Pt also stated that she had been spotting, and that she was earily for her period.

Her LMP was in sept.

unknown but the Dr had found trace blood in her urine.

???????????

 

[sir.shocksalot]

I have a Masters degree in a medical science. I know a little bit about flying a helicopter but don't feel qualified to tell my pilot how to do his job.

The key is medical education. Unfortunately, in the U.S. EMT-B is only 110 hours with no prerequisites required. While some of us do know there are others with more education, it is difficult to remember everyone's resume. If your degree is not in medicine you may be well educated but not in medicine.

Taking statements at face value because the is always the way you learned it or has been the practice forever doesn't always make it correct. Thus, the reasons why some of us want to raise the bar on education and patient care standards.

I just don't like seeing EMTs be belittled. We all started somewhere, and to step on someone starting out, who is trying to better their education, is asinine, rude, and extremely disrespectful. My argument was, does the location of a temperature make a difference? the answer is yes, and it was explained to me. Result was that I learned something. Did any of that warrant an attack on my qualifications, or my intelligence?

 

[VentMedic]

I think they were going to let the hosp do that where the lab stays open 24 hrs a day.

The ED doctor probably already got a report from the other physician which is why a r/o sepsis dx was announced upon arrival. That again may require lengthy hospitalization and treatment.

 

[AJ Hidell]

Last time I checked I get paid to treat patients, which makes me a professional.

Three weeks of night school doesn't make anyone a professional.

You can tell me how little I know until you are blue in the face, end result is with both are in this business to treat patients.

Correct. But just a moment ago, you were telling me that you don't have the "luxury" of conducting a proper diagnostic examination on your patients. So please forgive me if I find that somewhat distracting from your claims of professionalism.

I encourage you to correct me, that way I learn, which is and always will be my lifelong mission.

Excellent attitude! That is the key to success in this profession, and I wish you the very best of luck in that pursuit. All I ask is that you do not come here and pretend to be my professional equal just because you picked up a patch somewhere. And when you presume to lecture me on what we do and do not do, that is how I take it.

I do not encourage you to belittle myself or any other EMT, we all started as an EMT, and viewing us as nobody's will not land you in any EMT's good graces.

I haven't needed the assistance of an EMT in over two decades, so I am really not too concerned about maintaining their good graces. I can and do live quite happily without them.

Before you assume that I "don't need all that book learnin" I am probably just as well educated, if not more so than you, it might not be in EMS, but I am very well educated, so don't assume I am some Joe Blow who got their EMT to drive an ambulance around.

Wonderful. Please invite me over to the forum for whatever you got your education in, and you are welcome to tell me what I don't know about your field while I acknowledge your superiority. Meanwhile, you're in my house. Don't sit back on past laurels and let that prevent you from excelling in your new field.

Furthermore, what ever your views of this profession is, reality is that most ambulances DO NOT stock thermometers.

Some of the medics on this board weren't even born yet the last time I worked on an ambulance that did not have a thermometer on board. Sorry to hear that your system sucks.

 

[emtfarva]

???????????

I didn't make this stuff up. That is what I heard from the Pt's mouth.

 

[AJ Hidell]

I didn't make this stuff up. That is what I heard from the Pt's mouth.

LOL!

Anyhow, whatever test they did to detect the blood (either dipstick or microscopic exam) would have also detected the presence of pus, bacteria, or nitrites, all of which point towards a UTI. Micro exam would have given them even more than that, such as crystals, casts and epithelial cells. If they didn't mention other findings, either they weren't there, or else they didn't think that us "ambulance drivers" would understand anyhow, lol.

 

[sir.shocksalot]

Three weeks of night school doesn't make anyone a professional.


Correct. But just a moment ago, you were telling me that you don't have the "luxury" of conducting a proper diagnostic examination on your patients. So please forgive me if I find that somewhat distracting from your claims of professionalism.


Excellent attitude! That is the key to success in this profession, and I wish you the very best of luck in that pursuit. All I ask is that you do not come here and pretend to be my professional equal just because you picked up a patch somewhere. And when you presume to lecture me on what we do and do not do, that is how I take it.


I haven't needed the assistance of an EMT in over two decades, so I am really not too concerned about maintaining their good graces. I can and do live quite happily without them.


Wonderful. Please invite me over to the forum for whatever you got your education in, and you are welcome to tell me what I don't know about your field while I acknowledge your superiority. Meanwhile, you're in my house. Don't sit back on past laurels and let that prevent you from excelling in your new field.


Some of the medics on this board weren't even born yet the last time I worked on an ambulance that did not have a thermometer on board. Sorry to hear that your system sucks.

No I don't have the luxury of taking a patients temperature, I call it a luxury, because that is one piece of equipment I don't have. I don't claim to be your equal, however the difference between you and me is that if you stepped into "my house" I wouldn't belittle you for not knowing as much as I do. Why? Because we all start somewhere.

 

[CAOX3]

Originally Posted by AJ Hidell
Three weeks of night school doesn't make anyone a professional.

Correct. But just a moment ago, you were telling me that you don't have the "luxury" of conducting a proper diagnostic examination on your patients. So please forgive me if I find that somewhat distracting from your claims of professionalism.

Excellent attitude! That is the key to success in this profession, and I wish you the very best of luck in that pursuit. All I ask is that you do not come here and pretend to be my professional equal just because you picked up a patch somewhere. And when you presume to lecture me on what we do and do not do, that is how I take it.
I haven't needed the assistance of an EMT in over two decades, so I am really not too concerned about maintaining their good graces. I can and do live quite happily without them.

Wonderful. Please invite me over to the forum for whatever you got your education in, and you are welcome to tell me what I don't know about your field while I acknowledge your superiority. Meanwhile, you're in my house. Don't sit back on past laurels and let that prevent you from excelling in your new field.

Some of the medics on this board weren't even born yet the last time I worked on an ambulance that did not have a thermometer on board. Sorry to hear that your system sucks.

Wow, now that you got that off your chest.

Somedays I feel like EMS has a chance other days.....I think they should just turn the lights off and lock the doors.

 

[RESQ_5_1]

I would have to agree with you CAOx3. It seems to me like most of those that have the knowledge only like to dispense it with an air of superiority. Or, they will simply use their knowledge to remind you how completely ignorant you are and unworthy of any respect or dignity.

I can't see why we, as professionals, cannot just get along.

 

[Ridryder911]

I would have to agree with you CAOx3. It seems to me like most of those that have the knowledge only like to dispense it with an air of superiority. Or, they will simply use their knowledge to remind you how completely ignorant you are and unworthy of any respect or dignity.

I can't see why we, as professionals, cannot just get along.

Just because you belong within a profession does not make one a professional. As well, look up the requirement of what is required to be a real medical professional.

What I feel is occuring is many of us that attempt to suggest or comment are only to be told...”No its not that way" or "sorry; I don't have this or that" even including knowledge. I swear, that attitude and demeanor would have never been tolerated when AJ, Vent & myself started. If one did; you would had found yourself to have been black balled or terminated immediately. Your right, everyone starts out somewhere, but as well realize if you ask questions expect answers and assume that they will include something you did not know or do; hence you would not be asking them. Furthermore; medicine for us experienced clinician is a very serious business. This is not a hobby, a fad, or we plan on jumping into a new career nor use this for a stepping stone.

Seriously, consider this. Vent alone has spent over six (6) years alone on respiratory studies. Not 8400 minutes of training. This does not include her EMS education. As well AJ has spent over two to three years of time in education for Paramedic (not including numerous other hundreds (literally) of other associated classes, not including his RN and degree in science. Even in my experience, I have performed in clinical time alone in comparison to work would be over 6-7 years, as well over 6 years of academia. The acculmulation of experience between the three of us is over 120+ years.

Then you want us to appreciate or honor your 140 clock hour class and then inform us how things are? Yes, we may come across as arrogant and that is not the intent.

I highly suggest watching "medical grand rounds" to see how real medicine is taught and what is expected. It is not sugar coated or diluted for one to be able to understand it and yes, EMS is medicine.

Now, we have offered suggestions. Don't like them... so be it. Service can't afford basic necessities; that is B.S. Please don't say it’s a luxury for such a simplistic device, even mommies buy them for their babies. What's next thing not having sterile bandages?

Also don't make assumptions. No, I did not start out as an EMT. I started and ended my Paramedic program without EVER being an EMT first. My first certificate stated MICP, not EMT nor was I ever an EMT until the NREMT required you to be one to test to be a Paramedic nearly ten years after I started in EMS. Rule #2 Don't make assumptions.

Learn and read between the line from those experienced providers. They really offer more than the answer sometimes. Sometimes, we even attempt to make you think!

R/r 911