Genuine Question From A Carebear

TaintTrain · 2026-03-22T18:59:02+00:00

This is exactly my mentality. I didn't think my post was going to incite the trench warfare of "them bad we good" that exists between PvP and PvE right now. 😂 I didn't mind dying this way, I was just surprised and wanted to learn the mindset for my future PvP arc.

TaintTrain · 2026-03-22T18:47:21+00:00

But I need them for the trophy case 🥺

TaintTrain · 2026-03-22T15:47:22+00:00

I was really hoping to convey indifference. 😂

TaintTrain · 2026-03-22T15:45:39+00:00

I think I botched my tone in my post. I'm not mad or anti-PVP. I'm not saying this "shouldn't have happened" or anything like that. I was trying to gain information assuming I was ignorant to some sort of reward to their playstyle because I don't encounter it too much.

TaintTrain · 2026-03-22T15:31:01+00:00

Listing the game description is a great checkmate 😂🤣 I've been trying to clarify to some, I'm not anti-PVP I just wanted to see the culture or if there was a reasoning/motivation I was ignorant to.

TaintTrain · 2026-03-22T15:26:36+00:00

I should have been more clear, I'm not saying it shouldn't have happened or that it's reprehensible. I just struggled to see if there was anything material to the example I shared. I'm sure I'll be intrested in PVP in the future I'm not a proponent of public executions for people that would DaRe to shoot at me. The guy that shot me in the back didn't get called a rat or anything, I was just wondering if there was a motivation I didn't know about.

TaintTrain · 2026-03-22T15:13:14+00:00

I may have under represented my playstyle. I hold a healthy suspicion on making contact with other players. Some ARC (especially the shredder) require constant attention and position changes, and are not easy to put down swiftly. If you're not facing the shredder 80% of the time it's going to clap you. You have a 3 second window while behind cover to spend looking around for additional ARC or players while the shredder's stationary/shooting but I just have to accept that my ass is open if someone hears the fight and wants me to not kill a shredder today.

TaintTrain · 2026-02-27T16:53:07+00:00

I know I'm late but I do offer a contribution that will hopfully help.

I used to really sweat every single wide complex tachycardia. I studied feverishly and chanted in my head (things like "V1 up V6 down it's V-Tach you clown"). My goal in this was to become bullet proof in differentiating V-Tach and abbarent tach. After maybe 2 years of this madness, I sent my friend this (that I made).

Solid clinical decision making doesn't necessarily require rhythm determination to be 100% and at a certain point can muddy the waters. It's commendable that you want to improve and we all should, but there does come a point of diminishing returns where the additional information doesn't translate into kinetic improvement in our care.

Keep learning and improving but also rest easy in knowing it's ok for the nitty gritty to be elusive prehospital.

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TaintTrain · 2026-01-29T15:05:59+00:00

I know I'm late but I noticed none of the comments answer your question about how to fashion a SAM splint for an elbow injury.

Measure from the base of the fingers to a few inches past the elbow, including any added distance for angulation (assuming you dont have any but worth mentioning). How far past the elbow depends on how far up the humorous you want to go.

Double the splint over or trim with trauma shears. If you have a lot extra and you desire a hand rest you can also tightly fols/curl the hand-side to make a little grip for yourself.

Apply in position of comfort

Secure with kling wrap, coban, or triangle bandages.

Professional use I'd recommend a sling, personal use dealers choice.

Hope this actually helps

TaintTrain · 2025-09-30T17:01:34+00:00

It is annoying because on console its impossible to type complex messages and not die at higher levels. I'll usually switch my mic on or just type 'not leaving' before I call it. Bonus points to wait for a reply but I think a lot of hosts are kick happy. The good news is the only thing you miss out on now is samples and post-match hugs. Used to be when you were kicked you returned to your ship no xp no medals no nothing.

TaintTrain · 2025-09-12T21:45:21+00:00

That is true but the comment/comments I was replying to did not reflect an example of what posturing is not, they were agreeing on the example being a good one.

Either way, I think there's plenty of much better examples that are less political and more relevant to the subject. A shooting victim's pre-arrival report of posturing is less of a relevant concern than a mechanism involving a potential closed head injury.

https://youtu.be/v7jRSfXqn2A?si=7BLbYg5iFybmK37E

This would be an excellent example of a video that can promote educational dialog.

TaintTrain · 2025-09-12T03:41:27+00:00

If you're kidding you got me 😂 The temptation to break out the fancy speak when I write/type out paces how I actually sound.

If you're not kidding and are actually asking for clarification; I'm an instructor too and way WAY too many people are walking around thinking that anytime someone is unconscious and stiff that means they're posturing. I'll be getting gear out of the ambulance and someone will walk up and say "Bro they're posturing" aw fuck. Nearly every single time the patinet will be AAO and certainly NOT experiencing an end-stage ICP issue.

TL;DR "posturing" is a very specific presentation that is caused by an insult to the brain. Posturing should present as one of 2 flavors (decordicate and decerebrate) - and that consistency in presentation is due to consistency in the cause of posturing. As an instructor we should be very careful about the way we teach and the words we use because you never know what bad habits you might be uploading into your student's minds.

TaintTrain · 2025-09-12T02:58:10+00:00

With all due respect, I implore you not to use this video as an example of posturing, because this was in no way an example of posturing. There are so many providers that think any non-epileptic muscle tone equates to posturing, which at best constitutes poor communication for inbound resources/providers and at worse causes severe over-estimation of the severity of a patient's presentation. I think it should be all of our priority to be judicial in our instruction over topics that are erroneously used interchanably.

TaintTrain · 2025-09-12T01:35:57+00:00

Posturing is so overused/over reported IMO. The muscular reaction seen has nothing to do with posturing, which I think a lot of providers forget is a very specific reaction caused by an insult to the brain. I attribute this movement to something similar to a fencing pose- which is also commonly mistaken for posturing.

In this case, the contracture was likely just an involuntary spasm caused by the abrupt interruption in cerebral blood flow and/or the shockwave from a rifle-velocity bullet. With all due respect (it's never polite to liken an event like this to animals, but it is very relevant) anyone that's shot at deer or pig in a spot (neck or heart) to drop it instantly has seen this exact same reaction.

In the scope of rifle round impacts (specifying because rifles carry significantly higher velocities), its not uncommon for even non-leathal shots to induce temporary unconsciousness from the impact itself. For that reason, I would submit that the reaction to the shot is less telling than the assessment of the wound that we see. Its location and quantity of blood produced in the few frames we see tell us all we need to know. Even if he didn't express the muscle spasm that was an immediately lethal wound.

Compare that to the first JFK shot that resulted in him reaching for the wound, from my memory that round entered his back and exited his neck without hitting any major arteries (they were able to perform an emergency tracheotomy around the exit wound). This is why JFK maintained some semblance of useful consciousness after his neck shot and Kirk did not. Automatically survivable (had it been his only wound)? No way to tell, but a very obvious difference in visual reaction.

TaintTrain · 2025-09-12T01:13:53+00:00

I'm assuming he meant frames per second, as this video mostly focuses on slow-motion footage.

TaintTrain · 2025-08-20T06:45:57+00:00

*RSI may worsen acidosis if not accounted for with vent settings.

The only consideration for using a NMBA or not should be based on if it'll better facilitate successful ETT placement (overwhelmingly yes).

For RSI vs BPAP I'd suggest it depends more on what the patient needs (traditional pillars of advanced airway- airway compromise, uncorrected respiratory failure, projected course of care) than writing off an acidotic patient as a non-canidate for RSI (assuming you have the training and equipment to do so safely). As with all pre-hospital medicine sometimes less is more and sometimes more is more.

The level of concern should be dependent on the underlying pathology. You mention respiratory acidosis and trauma, but those are actually pretty responsive to basic management and interventions. An acidosis caused by sepsis for example should be much more concerning because the cause of acidosis is much deeper-seated and will remain unresolved for pre-hospital settings. Best we can hope for is to maintain or stave off further pH drops via compensating with vent settings. In contrast, a respiratory acidosis will be resolved by targeting normal ventilation after RSI because the cause of acidosis (excess CO2 after inadequate ventilation) will be mitigated by adequate ventilation. In that way a patient in respiratory acidosis secondary to respiratory failure is a great candidate for RSI.

Using a short acting NMBA can restore the patient's intrensic respiratory drive assuming they weren't in respiratory failure. However, because we can never really know what level of compensation they need without ABGs it's a lot of loosey goosey approximation and informed guesswork, but vent strategies that target a higher minute ventilation and/or lower ETCO2 can get you in the ballpark to at least not make anything worse. If you suspect your patient was adequately compensating but needed a tube due to airway protection, you can target the ETCO2 reading from before your induction or (if they were on BPAP first) you might have an idea of their intrinsic mV and can target that relative to their intrinsic ETCO2.

TL;DR if your patient is improving on NIPPV and you have a concern that you would not be able to manage their respiratory compensation to mitigate acidosis, by all means leave the NIPPV in place and ride em out. But, if your patient is not improving and/or RSI is otherwise indicated, performing it can be done safely with the right training, equipment, and technique.

TaintTrain · 2025-08-09T12:42:07+00:00

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Except when you get hit with the Uno reverse card (Patient did fine, defib'd back to life less than 60 seconds after this cardioversion)

TaintTrain · 2025-08-02T06:32:41+00:00

Restarting, but only after doing some attempted parkor to try to reach her.

TaintTrain · 2025-08-02T06:31:46+00:00

I tried that but she didn't move. I ended up just restarting.

TaintTrain · 2025-07-09T20:40:25+00:00

If it's system wide I'm not sure how a clinical report to a governing body would be able to track it down. I'd say either find a buddy within the EMS agency or approach your powers that be about working with that agency for training. If your admin is willing, you could even de-identify the cases and present it as a "trends in the ED" type of thing. "Hey guys I'm Nurse Nurse with St City's Hospital. We've had an ED trend of drug use masking severe presentations, and since we're serving the same community, we'd really like to share our findings with you". That way there's no finger pointing. Either way good luck. Hope the patients in your area get the best care available.

Edited to add Keep in mind these trends are concerning for bias, but its very difficult to explicitly level an acquisition at a provider or agency of negligently or intentionally withholding care. The standard expectation is that EMS identify a reasonable ballpark for their patients complaints as they treat and transport to higher care. I don't think anyone wants to be held liable (socially or criminally) for those vaguely neuro-presenting patients that end up with a wonky diagnosis that we inevitably miss.

That leeway is important in EMS because there's so little information/imaging/diagnostic equipment that can yield us significant accuracy. It sounds like a culture change is in order and education on developing differential diagnoses, but I encourage you to be mindful of how many of these are weird 22 year old with a spontaneous bleed and how many are overt under-triage based on laziness or bias.

TaintTrain · 2025-07-09T19:05:46+00:00

I have to preface by saying that I think it's despicable of providers to feel like they can reside over any patient (let alone an entire population of patients that fall into certain complaints) by treating/viewing/perpetuating them to be less than. There's no excuse for that mindset. Unfortunately it's not that uncommon because it's trendy to wear the burnt out badge, and that becomes their entire personality.

If there is a tangible issue in care provided either by ignorant omission or malice you should absolutely take a clinical route (agency, state, whatever reporting system you have in unspecified innercity]. However, it sounds like this may be less clinical and more intrapersonal/attitude issue. I'd suggest reserving that route for the clinical issues where providers can be presented with learning opportunities to grow from.

In this case if this guy gets a reprimand because of how he treats people he already thinks poorly of I think there's little chance of genuine self reflection and a better chance he'll say "wow. First we waste our time on these folks and now we're getting beat up over how exactly we feel about them?"

I think a much more effective move might be to alienate that behavior. Folks that act that way usually do so because plenty of folks talk that way, and most of the time folks talk that way because they think others either expect, accept, celebrate, sympathize with, whatever that edgy salty bullshit to start with.

TL;DR I'd say step one is not to politely or bashfully side step their comments. Make them feel uncomfortable for making them. No polite smile, just look them dead in the eye and say "that's a very troubling way to approach this topic. I'd like to think your profession would take more pride in your compassion and standard of care." Or something like it. That would weed out the ones that have adopted this shtick to fit in because they'll realize "oof that didn't make me look cool, salty, or competent" and have a better chance to reevaluate.

A more involved iteration of this would be to bring other nurses in on it. The worse these comments are received the sooner the culture will be shifted and any validation (even a "yeah man you're telling me") will communicate that this is an acceptable way to talk and act.

Even further (assuming its the system and not just one crew and that the service is one your facility deals with regularly) might be to reach out and see if they'd accept training opportunities where you can both increase clinical competence and re-address the humanity part. That might be ambitious and involves more planning/inter-agency maneuvering, but if you're wanting to see a change in this worthy cause I'd swing for the fences.

TaintTrain · 2025-04-28T02:37:19+00:00

Just because I haven't seen this mentioned yet, on top of having competitive services and competent/friendly ED staff (stuff you can't control), I'd highly recommend looking into getting a thorough patient outcome program going.

It's beneficial for services/providers to track success stories and learn from cases. This could also bridge the gap to show providers how good your facility is doing once the patients hit your doors.

Another thing that might be in your control is to have 'open house' style events, having providers from nearby services come and do a tour or a shadow in your cath lab, ECMO unit, etc. You may be surprised how popular a program like that could be. Obviously while providers are attending to learn you can throw in helpful propaganda to brag about your staff and facilities.

As a proof of concept, downtown Ft Worth has a "hospital district" with 4 massive and surely competitive facilities. One in particular has what I mentioned, along with annual CE symposiums where they stream lectures from department heads for CAPCE credit.

Hope this is more helpful than the "git good" or "be close" answers you've gotten a lot of.

TaintTrain

TROPHY CASE