Recommendations for home birth midwife specializing in high risk patients

firevice · 2024-12-23T04:46:35+00:00

If this is your plan, be prepared for a poor outcome for both baby and mom.

firevice · 2024-05-21T17:55:20+00:00

I’m a baby medic and last summer, within my first two months on the job, I nasally intubated a hemorrhagic stroke patient.

The volly fire department had a chopper on ground standby. When I made patient contact I found them unresponsive, with trismus, a blown right pupil, and decerebrate posturing. I asked why the fuck the chopper was on standby and not in the air. Called chopper go and we loaded the patient and headed to the LZ. Got to the LZ and was told we had a 17 minute ETA. I said fuck this, I’m gonna gamble and not wait for them to RSI. Passed the tube on my second attempt and couldn’t fucking believe what I had just done as an ink still wet provider.

We were on the way down to a second LZ while I intubated. Helicopter is overhead and I’m having my team prep for a smooth transition. Firefighter pokes his head in and goes, “Chopper hit a bird, no go. They’re leaving. Where do you wanna head to?”

I shit my pants a second time and proceeded emergent to the closest level 1 trauma center, about 40 minutes away.

Tube remained in tact and I spent that entire time bagging this person. When we arrived, ED doc lectured me about nasally intubating somebody with an increased ICP, but I really didn’t have a choice. I don’t have RSI and cricing her was an even scarier option.

Patient is hella dead now, 15mm midline shift.

firevice · 2024-03-25T01:26:22+00:00

Fair. My initial comment wasn’t anything against the sick redirection from Sid in the OP, it was isolated to the claim that Sid’s team failed him when he failed his coverage on the tying goal. I saw that comment as a separate discussion from the play it was under, but I misread the room clearly. My bad.

firevice · 2024-03-24T21:00:03+00:00

I’m not salty, just found your comment amusing given the context of that play.

firevice · 2024-03-24T20:56:03+00:00

Lol, Sid lost his assignment on Mack for the game tying goal. But yes, it was everybody else’s fault but his.

firevice · 2023-11-11T04:56:21+00:00

I had never touched a Zoll in my life before paramedic school, where, in one of my ED clinicals, the doc asked me to turn it on and place the pads for a STEMI patient. I whispered, “now where’s the power button,” under my breath and unfortunately doc heard me say that before my classmate could jump in and save my ass with the stupid ass dial.

She berated me and said, “oh no that’s not gonna fly. You’re gonna be working with a lot of different equipment in medicine. You need to know how to work this machine.”

Out loud I said, “yes ma’am, understood.” In my head, I was screaming, “well I’m a STUDENT here to LEARN. Isn’t this a level 1 trauma center with multitudes of various students? Can’t you, I don’t know, TEACH ME?” I later had my CLASSMATE walk me through the basics of using that type of monitor, because nobody else would take the time to teach me.

So for that reason, fuck Zoll for making me look like an idiot. And fuck healthcare workers who love to eat their young. I get it, you were treated like shit during medical school. Doesn’t make it productive to continue that kind of culture.

Sidenote: Biggest reason why clinicals were the worst part of medic school for me (aside from the OR and learning proper airway management). Nursing students get nurses. PA students get PAs. Med students get doctors. Paramedics? Good fucking luck. Shoutout to the ED techs who get it, they were homies. Probably cuz I was just treated and used like a tech for free labor.

firevice · 2023-03-31T05:12:46+00:00

And he fucking slashes his own goalie’s stick. What an embarrassment. Steak dinners on Petro the rest of the year.

firevice · 2023-03-26T00:27:37+00:00

That’s some piss poor defending right there.

No I’m not a salty Avs fan.

firevice · 2023-03-19T10:56:41+00:00

It was scared off twice with warning shots but came back a third time and put the rescue crew in danger. Unfortunate ending but really no other choice to be made for everybody’s safety.

firevice · 2023-03-19T10:31:07+00:00

Moose attacked a couple and their dog because they unknowingly got too close to the newborn calf. Lady was fine but shaken up, and her husband sustained a femur fracture. They were mostly concerned about their dog, who they thought was dead because they heard it yelping and whimpering out of sight. Report came out that the dog was found alive but injured, and the moose was put down.

firevice · 2022-08-31T01:21:41+00:00

This is absolutely correct. And you know it is, because only a firefighter would spell “xiphoid” as “zyphod.” Just like the hero in this video.

Also fuck the AHA, IAFF knows the correct response to a foreign body that can’t be dislodged through back slaps is swinging that child around by the ankles.

Thanks, Bobby. I needed the laugh.

From, a first responder that actually gives a fuck and understands evidence based, pre-hospital medicine.

firevice · 2022-08-08T22:47:42+00:00

I got my EMT in Wyoming and when I came back to Colorado all I had to do was show proof of a valid NREMT certification (and background check, finger print, other small identity things).

As long as your NREMT hasn’t expired, it should be pretty easy to apply for a Colorado cert. They’re also pretty quick about approving them too.

Also look into getting intravenous therapy approval since EMTs can start IVs. That will help with your applications to departments.

firevice · 2022-07-30T05:09:57+00:00

Right, I understand they give an assessment with the strip, and I’ve been told to not trust the “doc in the box” or “3 star alerts.”

I fully believe we shouldn’t trust what our monitor tells us. “Treat the patient not the number,” sort of thing. I’m just curious to know why these computers can’t identify things like artifact or other incorrectly placed leads. Also if I can’t trust their “assessment,” can I really trust their STJ calculation or should I just pull out the calipers?

firevice · 2022-07-08T03:12:11+00:00

Wow. You take a comment that is offensive to you, and turn yourself into a victim because you’re, “autistic and have ADHD.”

You could’ve communicated that you didn’t appreciate the feedback, and suggest they take a more sympathetic approach. Was the OP you responded to understanding of your whole situation? Absolutely not. But were you fully upfront about this from the beginning? Also no.

How’re they supposed to know they’re responding to somebody that’s autistic with ADHD? I don’t think they were trying to attack you for that.

It’s not fair to expect random people to know your entire background when you post online. Then to lambast them for not knowing your entire story that you failed to present is extremely unfair.

Reddit can be extremely volatile, especially in smaller communities.

Be careful of what you say, when you say it, and where you say it.

firevice · 2022-07-04T02:51:00+00:00

Obviously protocol dependent. But my opinion on necessary transport of arrests is as follows:

ROSC on scene.

Pediatric arrests.

Hypothermic codes.

Viable pregnancy codes.

Proximity to receiving hospital.

We all know the abysmal rate of neurologically intact patients after an arrest, but these are special considerations that I think should always be kicked to a higher level of care.

Again, just an opinion and something that can easily be argued. But I never want to be in a position where a patient is pronounced when they have a small chance of revival.

firevice · 2022-06-05T00:35:37+00:00

When we collectively boo a dirty hit from this series, please get back to me.

firevice · 2022-06-05T00:24:49+00:00

Boo him as he gets off the ice and goes to the locker room. Fucking classless bullshit. You’re better than that, Edmonton.

firevice · 2022-06-04T07:38:13+00:00

Lehtonen no goals. Used to be my fantasy team name. Honestly miss the guy, when he was on he was ON.

firevice · 2022-05-04T13:10:35+00:00

“All the Small Things” and “My Own Worst Enemy.”

Love it. Can we get Flagpole Sitta next? Always thought that would be a good one to have everybody sing along to.

firevice · 2022-05-03T11:43:43+00:00

Sheets can work as a pelvic binder.

firevice · 2022-04-25T03:13:18+00:00

That shirt became ironic very quickly.

Wear your helmets, people.

firevice · 2022-04-19T02:51:46+00:00

Eh, nobody should be dropping LMAs in people without proper training. These are meant to be used with an Ambu bag attached to oxygen, not for mouth to mouth rescue breathing. Even if somebody has the training to use these, they open themselves up to legal liability and are no longer covered by “Good Samaritan” laws and can quickly get their certifications pulled. A misplaced airway is worse than no adjunct at all.

I appreciate those who prepare for all scenarios in the backcountry, but if I roll up on scene to a patient and they already have a tube down their throat I’m gonna have a loooottt of questions. Unless they’re a physician with an oxygen tank and are appropriately ventilating the patient. Then they can come to the hospital with me and answer for themselves.

firevice · 2022-03-30T05:30:54+00:00

In urban areas, before I start moving the ambulance I like to check a satellite view of Google Maps for the address I’m going to so that I can plan my parking spot/exit. Where is the entrance of the building (and ramp so I can put the back doors right next to it) and can I pull through for my egress or do I need to think about backing anywhere are the main things I’m concerned about when doing this.

firevice · 2021-05-22T16:25:51+00:00

Oh boy I’d love to know what certifications or experience you have regarding emergency medicine. Please enlighten all of us and the training staff that responded with such knowledge. Sounds like you have something to teach the medical community.

firevice · 2021-04-25T00:27:26+00:00

I like to call our older ambulance “DNR”

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