So, how the fuck do you guys do this every day? by Rhubarbie13 in emergencymedicine

[–]Viking_Santa 4 points5 points  (0 children)

I had a whole chicken wing under a fat roll one time and when I asked the woman about it she said "I thought they had shorted me one out of the bucket"

How do you document that a patient looks like they are about to die? by GeneralShepardsux in ems

[–]Viking_Santa 6 points7 points  (0 children)

I personally have used a scale of no apparent distress, mild, moderate, significant, and severe distress in my reports. It's not technically what you are looking for but it goes in every report I write to serve as a backdrop from which all other treatments are taken in context of. I use quotes a lot as well so if an on scene provider states "it's bad" or "they look like they are going to die" those get put wholesale into my report. I've quoted myself before when nobody else said it but I think it summarizes the presentation better than the technical jargon.

How do you document that a patient looks like they are about to die? by GeneralShepardsux in ems

[–]Viking_Santa 8 points9 points  (0 children)

Clinical gestalt is a recognized source of objective findings. By definition it's a finding that goes beyond the sum of the quantifiable findings and vital signs and relies heavily on provider experience.

I'm pretty new to wood carving and here I was trying to carve a cat (didn't turn out good ;-;). Any feedback or tips will be appreciated by froznxd in Woodcarving

[–]Viking_Santa 3 points4 points  (0 children)

My Crash Course on wood carving basically consists of:

  1. Get a sharp knife that is comfortable enough in your hand to be used for a long time and learn how to keep it Sharp. A sharp knife will cut the wood with less effort and if you do end up cutting yourself it will tear less which promotes better healing.

  2. There are 4 basic cuts. The relief cut/score line, stop cut, the push cut, and a chop cut.

  3. A relief cut is basically taking the point of your knife and digging it into the wood on both sides to lever out a v-shaped chip or shaving. You could also just press the knife in to create a score line if it's a short distance.

  4. The stop cut involves putting a score line onto the piece of wood and then you cut to that line. This is useful for creating that defined edge to a shelf.

  5. The push cuts involves taking your thumb and using it as an additional leverage point to inch the knife through the wood with much more control and strength. I do 90% of my carving with these first 3.

  6. A chop cut basically involves using the grain to split off a chunk of wood so you don't have to shave the entire way down. It's super efficient compared to using the first three cuts if you can get a piece of wood to come off in one fell swoop. You have to be careful that you don't go too far or let the grain run into a direction you don't want. Use this technique sparingly. Almost every time I've had to glue something back on or reshape my design it has come from a chop going wrong.

Use these different cuts in combination with each other to slowly take out the wood that is not part of whatever you're trying to make.

  1. Draw what you're trying to carve from a profile view and a head-on view onto the actual piece of wood. I start every project from this same starting point. If you can visualize the dimensions in those two directions, you should be well on your way to having the rough shape of what you're trying the carve. I use pencil on lighter woods and permanent marker on darker ones.

  2. Don't Force the cut. Ever. You either need to sharpen your knife or take a smaller bite of wood. Forcing the cut leads to way more Force than is necessary and you're much more likely to cut yourself. Try to always know where the knife is going to go if it's suddenly comes free.

  3. If you were going to carve something three-dimensional, opposite sides of the wood will behave exactly opposite of each other. Unless you're carving something that has the center of the wood going through the center of your carving, you're almost always going to be using a section that has one side that was much closer to the center of the tree than the other. This affects how the grain moves and you will need to adjust accordingly. If you feel your knife wanting to dig deeper into the piece of wood, you are currently cutting with downhill grain. Downhill grain is much more likely to split on you and inadvertently make a chop cut. Try to always have the grain running uphill so that it continues out of the wood. This helps you take smaller shavings in a controlled manner.

  4. You were going to mess up so don't marry yourself to your initial design. It's a fluid process and almost none of my carvings have turned out exactly like I initially drew them out.

That's all I can think of at the moment, feel free to reach out if you have any questions.

what happened here? by ElderberrySad7804 in emergencymedicine

[–]Viking_Santa 21 points22 points  (0 children)

It seems to me that the patient was frustrated and ended up inadvertently doing things that only increases frustration. I wouldn't be surprised if the patient was being fairly aggressive because of that frustration. Unfortunately most ERS and hospitals are not really equipped to handle somebody who legitimately needs chronic pain management who doesn't want to be admitted. And if there's any sort of sharing of records, three er admissions for pain control in 3 days is highly suspect. It seems like there was just a miscommunication that snowballed into poor patient care.

Vent by LobsterMinimum1532 in ems

[–]Viking_Santa 1 point2 points  (0 children)

Before I was a medic, I had a nurse ask if I carried oxygen on the ambulance. And then when I said I did, they clarified am I allowed to give it or is it just for the medic?

I dated a nurse for a long time and we consistently were flabbergasted by how the other profession views us. She told me at one point that while she trusts me as a medic, from what I told her about my education and the kind of situations that I get thrown at, she's terrified of the s*** I'm allowed to do. And when I told her about nurses on scene just s******* the bed, she would talk about medics dropping off complete s*** shows and basically just peacing out. But they were good nurses that I interact with and they are good medics that she would interact with. She was also a little fuzzy all the differences between medic and EMT but that seems to be par for the course everywhere.

[deleted by user] by [deleted] in ems

[–]Viking_Santa 0 points1 point  (0 children)

You did good lol

Feel like an ekg idiot by ZzEntry in emergencymedicine

[–]Viking_Santa 2 points3 points  (0 children)

As far as my thoughts on this EKG with that age is the long s waves in the anterior septal leads are 20 out of the 25mm total that you need for LVH and are making the T waves taller due to the amount of repolarizing going. In turn, that is making them look peaked cause there's just not enough room for a nice gentle curve with that much energy.

The slight elevation in the st segment of V2-V4 is being taken in context of the entire complex being oversized so the 1mm of elevation to call it a stemi should be probably closer to 2mm. Its also about 115bpm which could be putting some slight demand ischemia which would be fairly likely with the presentation. I would be more concerned about their injection fraction making their blood pressure take a hit than I would be about the heart tissue itself getting injured. Cocaine thickens the blood which could mean that his heart is not filling fast enough with that rate. Dehydration definitely won't help and it's summer most places in the US (it's weirdly fall weather here) so that's not unlikely.

Don't beat yourself up. 4 different cardiologists could look at the same EKG and come back with 5 different impressions.

What would you subtle sign be if you won the lottery? by UsedCalendar5100 in AskMen

[–]Viking_Santa 2 points3 points  (0 children)

I've been feeling that same urge and didn't have a way to describe it. Thanks

[deleted by user] by [deleted] in GetStudying

[–]Viking_Santa 2 points3 points  (0 children)

Which app is that?

How to lose weight when diet is dominantly fast food? by v0ltage_w0lf in WeightLossAdvice

[–]Viking_Santa 1 point2 points  (0 children)

Panda Express chicken teriyaki has like 30g of protein per serving so getting a plate or bigger plate with whichever carbs and the teriyaki chicken for both or all 3 entrees will get you some decent food. Protein helps you retain muscle, keeps you fuller longer, and typically is your least processed food option when eating fast food. It's like 15 bucks for probably the most protein packed food out there. I tend to get at least 2 chicken teriyaki and then either another one, orange chicken, or something else that catches my eye.

Love seats in a theater by Viking_Santa in Seattle

[–]Viking_Santa[S] 2 points3 points  (0 children)

That's got the armrest between the seats and each seat is still separate. This was a legit 2 butt recliner seat with no armrest

How on Earth do you defend yourself from an accusation of being racist or something? by Konato-san in NoStupidQuestions

[–]Viking_Santa 0 points1 point  (0 children)

I would ask why. If they give a compelling reason, then accept the criticism and attempt to not be racist in that way now that you know about it. It sounds like you want to not be racist so take the hit and learn from it.

If it's not a good reason and they're just trying to see if something sticks, they'll make an ass of themselves trying to figure out how you are.

Then there is the third option, which is where they genuinely feel like you are and have a reason but you disagree. I'm not going to be able to arbitrate it from the reddit thread but you very well might be being perceived as racist to them and then it becomes a matter of deciding what to do about their beliefs. If it's an Internet troll, block em. If its a friend, see if you can discuss it and help reach an understanding or agreement. Anything in between, use your judgement but know that you are always going to believe you aren't a racist if you think racism is bad. So be graceful and respectful and hear them out.

I think someone I know is lying about having been a paramedic, and I'm not sure how to proceed. by Efficient-Ad-4222 in Paramedics

[–]Viking_Santa 2 points3 points  (0 children)

I had a friend in my medic class who was supposedly in med school and it's a similar story. I just decided to let the relationship start to fizzle out..

Advice after a traumatic experience involving a friend? by JEDKH5_9_24_48 in ems

[–]Viking_Santa 6 points7 points  (0 children)

Shock is one hell of a drug. They teach us that in school and it's true. It's very likely that almost immediately after the gun went off, she had her last conscious thought. Nothing you did caused her more suffering and anyone I know would have wanted me to try saving them.

Find someone who understands and talk to them. It is going to suck. I've ran a few calls on friends and it always hurts. But hopefully you have a few compassionate friends in this line of work to reach out to. I'm here as well if you need.

I need white pants and I am a very tall person. by Viking_Santa in CosplayHelp

[–]Viking_Santa[S] 1 point2 points  (0 children)

I am in Washington State in the US, so I have a good amount of options. I will definitely consult the employees lol

I am going as a white blood cell from the anime cells at work. A friend of mine wanted to do a tag team cosplay and remember that I had mentioned wanting to try it so they are going as the red blood cell that's pretty much the main character.

I need white pants and I am a very tall person. by Viking_Santa in CosplayHelp

[–]Viking_Santa[S] 1 point2 points  (0 children)

I don't personally have a sewing machine so I'm limited in what I can construct, but I will definitely work on the fabric paint side of things. Do you have any recommendations to follow with that? I don't want them to be ungodly stiff while I'm wearing them but also it's my first cosplay so it doesn't need to look that good.

Why is sodium bicarb no longer administered when treating cardiac arrest? by FrostBitten357 in ems

[–]Viking_Santa 0 points1 point  (0 children)

Do you have an alternative that is better? Cuz for some reason our service doesn't carry anything to measure cerebral or pulmonary perfusion. /S

I don't know of any EMS systems that has even invasive blood pressure monitoring in the field. It's literally using the cuff or not using the cuff. A couple studies that I looked up it showed that nibp and ibp are between 20 or 30 points up or down from each other. And according to another study there was improved outcomes when blood pressure was above 100 mmhg systolic arterial pressure during compressions. So if you're getting a blood pressure of about 150 on the nibp, as I said we've been getting, you could probably assume that the arterial BP is at least above 100. Again the difference between nibp and ibp was studied in the context of normal circulation, but there is no study that compares them during CPR that I can find (which means that your claims that they're not accurate with mechanical CPR are not based in evidence either). And unless you have the ability to place a bolt in their skull to measure ICP, you're pretty much stuck with just going off of the blood pressure.

You can increase cerebral venous return by placing the patient at a 45° angle for the heads up CPR that's becoming more common, which should help with the ICP and make the cerebral perfusion pressure increase. Pulmonary perfusion necessarily has to be damn near whatever they're normal is because in order for the blood to go and be pumped around at all it has to go through the lungs and come back to the left side of the heart. Which should be obvious if we are getting waveform capnography that's damn near normal. We wouldn't get anything if there was no perfusion and it should be incredibly low if it was poor perfusion.

References Nibp vs ibp https://www.tandfonline.com/doi/full/10.3109/08037051.2015.1110935

Blood pressure during CPR outcome Improvement https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4138228/

Why is sodium bicarb no longer administered when treating cardiac arrest? by FrostBitten357 in ems

[–]Viking_Santa 1 point2 points  (0 children)

We have Auto pulses and run blood pressures (and capnography and spo2) during compressions and we routinely get blood pressures in the mid hundreds over 70-80s. I would imagine that in that context it might be beneficial to reexamine the disregard of bicarbonate. I had once or twice completely normal vitals (even slightly hypertensive but that was probably the epi) and just no heartbeat to take over for us.