is a broken arm an ALS or BLS call?

[Ensihoitaja]

Seconded. It’s an absolutely fantastic and highly relevant book.

It's also a Kindle Daily Deal on Amazon today- get it for $1.99! https://smile.amazon.com/Dreamland-...?s=digital-text&ie=UTF8&qid=1592177473&sr=1-6

 

[MackTheKnife]

Be sure to tell all your nursing instructors this philosophy and share widely while on clinical...it will bring you much success.

BTW, pain has been removed as the 5th vital sign.

 

[RocketMedic]

I’m pretty sure shoving a Tylenol suppository into a rednecks bum for his broken leg or pancreatitis is going to get me punched.
I’m also pretty sure that people in acute pain typically want some help.

 

[Peak]

I’m pretty sure shoving a Tylenol suppository into a rednecks bum for his broken leg or pancreatitis is going to get me punched.
I’m also pretty sure that people in acute pain typically want some help.

Well you should be getting consent before any intervention.

 

[RocketMedic]

Well you should be getting consent before any intervention.

“Hey I know I can see the bone but I need you to spread the cheeks.”

 

[E tank]

That's the attitude that a lot of people have, and it is actually a big problem. Physical pain is a normal part of the human experience and we should be able to deal with fair amount of it. The expectation of never having to tolerate any discomfort and catastrophizing about it and refusing to cope with it psychologically when it inevitably does happen is very self destructive - even if it doesn't ultimately lead to opioid addiction, which is of course the worst outcome and a shockingly likely one among patients who have the highest expectations for not experiencing pain. The medical community makes it worse by allowing patients to have unreasonable expectations and reinforcing the cognitive distortions that create further anxiety about pain and making it even more difficult for people to cope with. Then they throw opioids and anxiety meds at the the problem and everyone wonders what went wrong.

There is an entire medical sub-specialty that depends on "catastrophizing" pain for it's success with the complicity of OB doctors...it's labor analgesia. I've even had OB's request epidural catheter placement before induction of labor so that at the very first indication of discomfort, the epidural can be bolused with medication. Never had the heart to tell a mom that the pain of a teenager was far more intense than labor (and booze only makes it worse....)

 

[Peak]

“Hey I know I can see the bone but I need you to spread the cheeks.”

If that is your level of professionalism then you should probably work on that.

 

[Carlos Danger]

There is an entire medical sub-specialty that depends on "catastrophizing" pain for it's success with the complicity of OB doctors...it's labor analgesia. I've even had OB's request epidural catheter placement before induction of labor so that at the very first indication of discomfort, the epidural can be bolused with medication. Never had the heart to tell a mom that the pain of a teenager was far more intense than labor (and booze only makes it worse....)

OB call is the bane of my existence.

 

[Peak]

OB call is the bane of my existence.

I thought all the moms love anesthesia since y’all give the epidurals.

 

[Carlos Danger]

I thought all the moms love anesthesia since y’all give the epidurals.

Oh they do love us. To death. It's not usually the moms who are the problem, though they certainly can be difficult. It's just that OB is a strange world where the rules and expectations are different. Anesthesia providers tend to love OB or hate it. I……do not love it.

 

[DrParasite]

BTW, pain has been removed as the 5th vital sign.

according to whom? I saw many who wanted it removed, and recommending it be removed, but who actually made that decision, and where is it documented?

 

[RocketMedic]

If that is your level of professionalism then you should probably work on that.

Well it’s not like I’m actively spitting my dip while I get the drugs...

 

[Kevinf]

In that case BLS is more than appropriate. Our EMTs aren’t even trusted with oral glucose

I love our fractured EMS systems. For quite a while in PA, EMTs were trusted with oral glucose but not finger poke CBG. Even before that, there was a time where you could apply oxygen, but might not be able to check on SpO2.

 

[RedBlanketRunner]

What if the hand was pulseless as presented?

I think we all can hear a physicians review; "So you have a displaced FX. In the off chance that the artery was only constricted and not lacerated, which it was, you chose to return the arm to a neutral position?"

 

[RocketMedic]

I think we all can hear a physicians review; "So you have a displaced FX. In the off chance that the artery was only constricted and not lacerated, which it was, you chose to return the arm to a neutral position?"

As opposed to leaving it in a position with impingement? I know you’re not actually trained, certified or educated in emergency medicine or basic anatomy, but even a cursory Google search explains this concept quite well.

 

[E tank]

I think we all can hear a physicians review; "So you have a displaced FX. In the off chance that the artery was only constricted and not lacerated, which it was, you chose to return the arm to a neutral position?"

Don't know anything about some "physicians review"...but just for argument's sake...how many arteries are in an arm? And what role might collateral arterial flow play in the setting of an arterial injury? And what might someone do to optimize collateral flow in a pulseless limb?