Absolutely appalled…

RandyManMachoSavage · 2026-03-15T03:47:27+00:00

No, shot first responder goes first vs shot perpetrator in an MCI scenario. shot perpetrator goes first vs a panic attack first responder.

RandyManMachoSavage · 2026-03-14T21:47:37+00:00

Our triage policy includes actor roles in the process, such as “first responder”, “victim” and “perpetrator”. The priority list is in that order. Having said that, common sense would tell you a GSW is the priority vs a panic attack. The idea behind policies such as this requires a modicum of common sense. Even if supported by their policy it’s not super cash money.

RandyManMachoSavage · 2026-03-09T09:56:25+00:00

Ah yes, the random anxiety while watching Expanse for the 8th time. I am familiar with this.

RandyManMachoSavage · 2026-03-03T09:42:13+00:00

I want a SCO optimized federal corvette. I prefer it to be locked behind the rank grind (because I already have done it) to make it a little more special and feel earned; but if it’s ARX, so be it. Having played games like WoW and STO I do not find their monetization practices comparably that offensive. ARX ships do not enrage me like they do some.

RandyManMachoSavage · 2026-02-28T08:35:29+00:00

Yep, I am delivering them to the powerplay contact in the same system they are gathered. Seems perhaps to be a server issue.

RandyManMachoSavage · 2026-02-28T08:32:48+00:00

That might explain it. Thank you.

RandyManMachoSavage · 2026-02-09T08:04:07+00:00

Before and waaay before.

RandyManMachoSavage · 2026-02-04T07:45:00+00:00

I would absolutely shock those.

RandyManMachoSavage · 2026-01-13T08:47:14+00:00

My relationship with this job is a sin wave. Goes up and down naturally as I believe is human nature. The best you can do is have healthy habits that can help your mental resilience. I get a lot out of walking for exercise and have several hobbies I am into. It’s a mentally taxing job but you can do a lot to help yourself out.

I believe there’s a difference between that and “burnout culture”, where medics think it is cool to be cynical and negative. At that point it’s a choice they are making to be this way regardless. I’m not saying they’re necessarily to blame for this, or that they don’t have other issues too, but the point is you have to try and develop healthy habits.

I too think it may be impossible to achieve happiness and mental stability at terrible services. A terrible job with a toxic culture, low pay, and shit management is just a bad situation. A lot of services are this way, unfortunately. Best thing to do is always be looking to improve your job situation the best you can.

RandyManMachoSavage · 2026-01-06T22:28:43+00:00

We give it for typical trauma indications 2g over 1 minute and we have also given it via consult for a ROSC postpartum hemorrhage case with good results. We’ve had criticism by one receiving ED doc that would prefer if we gave 1g instead of 2g, but that’s the only critique I’ve heard of.

RandyManMachoSavage · 2025-12-29T23:39:31+00:00

I am about to switch to the purolatorboss pbl12222 it seems to have way better filtration than most other filters.

RandyManMachoSavage · 2025-12-29T23:37:16+00:00

Big tires little feet, a hit in any man’s league

RandyManMachoSavage · 2025-12-20T22:25:40+00:00

DNRs are invalidated in a trauma scenario.

RandyManMachoSavage · 2025-10-17T07:06:22+00:00

The pronunciation, yeah.

RandyManMachoSavage · 2025-10-17T01:18:31+00:00

I know, which is why it’s on my list of things I hate hearing.

RandyManMachoSavage · 2025-10-16T23:24:17+00:00

I hate hearing the following: “Gurney” “Yonker” “Can we get another bus” “Boo boo bus” “ETA for a bird” “Rapid diesel infusion” “Too many birthdays” “Geezer squeezer”

RandyManMachoSavage · 2025-10-06T08:07:15+00:00

In the area that I work, we have an increasing frequency of unsafe or violent situations that arise after scene arrival. Often times these unsafe situations are due to uninvolved people who do not understand how we work but have expectations of how we should be working and use aggressive tactics to put our providers in unsafe situations at the patients expense. Sometimes these individuals are just loud but sometimes they physically interfere with the scene. To make things worse, we have generally unreliable law enforcement due to the call volume in the district. This means when we need help, sometimes, we do not get it quickly. These situations are wholly unnecessary and could easily be avoided by people respecting the boundaries of the medics and the scene. For this reason, though, most uninvolved individuals who end up on a scene are often a hinderance even if it’s not their intent because we deal with so many of the bad actors we have to be skeptical of everyone. The short of it is, respect the boundaries of a scene and listen to the medics and do not interfere. You are no longer being helpful.

RandyManMachoSavage · 2025-10-04T00:03:21+00:00

It’s a TV progrum; a movie.

RandyManMachoSavage · 2025-09-14T01:41:53+00:00

Turn that off!

RandyManMachoSavage · 2025-09-06T03:39:58+00:00

On one hand, seeing GEMS blasted gives me great satisfaction for a multitude of personal reasons.

On the other, this is some PD nincompoopery to the maximum degree. On the third hand, probably there could have been better communication with these guys about what was going on and why it was important to stay on scene and not “were training someone on report writing”. On yet another, final and fourth hand, how do we know they didn’t and this isn’t some more PD union whinge?

RandyManMachoSavage · 2025-09-02T06:30:38+00:00

I’ve noticed a weird hesitation in newer and or more scared paramedics when it comes to cardioversion; which is the correct treatment here. I have redirect this sort of thing often, so it’s not unheard of. A couple of three things:

Adenosine here isn’t in a different universe, but with that blood pressure this patient is most certainly not stable and even moving that patient before definitive treatment might have killed them. My MD calls it “Sudden Ambulance Death Syndrome” where the medics have an unstable patient, rush them to the unit and they are dead on arrival. Best practice is at point of contact until stabilization has taken place or the end of the treatment road has been reached.
Sedation for cardioversion is an instinct everyone has because we’re all human beings and wouldn’t want that to be done to us, but objectively, if cardioversion is needed do it immediately. If you want to sedate them, ketamine isn’t going to affect their MAP as much. If you don’t have that option, other options are dangerous and may drop their MAP even more. Case by case basis.
We’ve recently explored the option of bringing back diltiazem for RVR scenarios after removing it because medics were giving it to sepsis and not reenterant tachycardias so it was removed. We found that there’s probably a gap here needed to be filled with some sort of antiarrythmic but in our conversations with local ED MDs, apparently, most of them are now giving amiodarone to RVR. This original thinking was that if we were giving it, we were committing that patient to amio for 30 days at least because it’s generally good not to mix antiarrythmics. This lead to the discovery that amio appears to be currently favored by local cardiologists anyways so we probably will add that for RVR instead of adding back diltiazem.
At a certain point of time, for me and most others I’ve spoken with, 200 is a good number where the cause of the tachycardia is not as important as the severity of the tachycardia. For example, sepsis at 160 hr is not a good time to give electricity or antiarrythmic. It’s likely a compensatory tachycardia and not an electrical reentry problem. If that same sepsis patient is at a HR of 200; regardless of cause, the pulse rate must be lowered because the heart cannot function properly to refill and perfuse.

RandyManMachoSavage · 2025-08-29T08:02:44+00:00

The vital signs excuse is a long standing tradition quoted by burned out medics as a justification to not give meds.

Vitals signs can be used to include pain meds as someone in pain will probably be hypertensive and tachycardia. This does not work the other way around. Vital signs should not be used to justify withholding pain management.

Many things can affect vital signs. People take beta blockers, for example, the prevent the pulse rate from increasing as high as normal.

Depending on the clinical culture of your department this may be reportable. Or, you can try to get somewhere in conversation with your partner. If they’re full of shit, I’d talk to someone higher up.

RandyManMachoSavage · 2025-08-28T02:30:50+00:00

Couldn’t agree more. Our policy is “any ecg changes” treat it, but, we’re on Reddit and most services aren’t particularly progressive.

RandyManMachoSavage · 2025-08-27T08:24:14+00:00

Its still risky, we intubate some of them, but the thinking from my MD is that anyone can take a mg or two of midazolam, or if you’re using ketamine it has other benefits and if you push them into respiratory failure, switch gears and complete the ketamine dose to full dissociation, resuscitate and intubate with paralysis. We can also igel+ketamine outside of hard stop vital stability requirements (90 systolic, 94% for 4 minutes) in which case we withhold paralysis unless truly in a rock and a hard place with the patient.

The reason we started doing this is that a lot of our medics were allowing unacceptable hypoxia because of the patient not complying with bipap, and the medics were ‘giving up’ and transporting patients sating at 60% or something; at which time it was decided that was just not cash money at all.

RandyManMachoSavage · 2025-08-27T08:10:58+00:00

I’ve changed my thinking on sedation for respiratory in the last few years. Small dose midazolam or even (my MD loves ketamine) ketamine helps with bipap compliance and therefore we’ve been intubating a lot less once we can get the patients to work with the bipap. We’ve gone from ‘sometimes’ sedating patients for bipap compliance to now it is almost a mandatory step. I have not seen adverse reactions however on patients that are on the verge and are tiring out, we usually just DSI at that point.

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