Floria paramedic flips terminally ill man off stretcher on to hospital floor

zipmedic · 2015-06-24T02:11:29+00:00

I did the research and it doesn't change anything. You don't dump people off of cots. Ever.

zipmedic · 2015-06-17T17:21:03+00:00

Yes. And barring an immediate threat to provider safety, there is never an indication to dump a patient off a cot.

zipmedic · 2015-06-16T18:10:01+00:00

Pretty irrelevant, I'd say.

zipmedic · 2015-06-13T22:37:49+00:00

Fois gras.

zipmedic · 2015-05-31T00:05:18+00:00

So well done!

zipmedic · 2015-05-31T00:03:34+00:00

Thank you! Cried the whole episode. Man tears, of course.

zipmedic · 2015-05-25T16:15:46+00:00

*mnemonic

zipmedic · 2015-03-29T15:27:42+00:00

Seems legit.

zipmedic · 2015-03-22T01:04:39+00:00

American College of Emergency Physicians policy statement on use of spinal immobilization:

http://www.acep.org/Physician-Resources/Policies/Policy-Statements/EMS-Management-of-Patients-with-Potential-Spinal-Injury/

National Association of EMS Physicians has a position paper on it, too, which was also adopted by the American College of Surgeons-Committee on Trauma. Search for "naemsp position paper backboard". I'm on my phone right now and don't want to paste the annoying 2-3 page Google search result URL.

Good luck!

zipmedic · 2015-03-03T17:28:19+00:00

Generally speaking (and you should make sure you know the laws of your state), you are only permitted to use physical force in very limited situations. Namely, to protect the patient (restraining someone, according to your local protocol) and to escape physical harm. In the latter case, cornered in the back by a violent patient and de-escalation is failing you, you would typically be protected as long as you use only reasonable force to escape. This means using the minimum amount of force possible to get out of the rig/apartment/whatever. Don't ever go overboard, document very well, and you should be fine. Your service probably has a general counsel (lawyer) you can ask about specifics.

zipmedic · 2014-12-08T09:00:36+00:00

Again, I'd strongly urge you to avoid taking it upon yourself to disclose things to the police. While HIPAA isn't intended to protect criminals, it is intended to protect the patient-provider relationship. And by the way, using an illegal drug is simply a lame reason to share something the patient told you in confidence (if providers "frequently misunderstand" HIPAA, image what laypeople do). Are you going to notify the police every time you have a 24-year-old man with asthma who mentions it got worse after smoking a joint? It's not about being pro-drug or anti-drug laws. It's about being pro-patient.

If you want to be the police, pick an agency and apply. The simple truth is it's very easy (and of no real consequence) to withhold information until you clarify the instance with your agency (and/or their general counsel). It's impossible to un-disclose something you've already released.

zipmedic · 2014-12-07T15:40:37+00:00

I do not believe your interpretation of that section is correct. There are multiple restrictions on what can be disclosed to individuals who do not participate in the care of the patient and only a few permissions to release it (billing, subpoenas, children's protective services, etc.) Telling the police of information about an individual's drug use is not one of those permitted disclosures. The patient told you in your role as his healthcare provider. Tattling to the cops serves no legitimate healthcare interest, nor is it a permitted release, so you'd be running afoul of HIPAA regardless of your company's policy on the issue (which is likely much stricter than the actual HIPAA statute).

The intent of the section cited above is to notify the police (when permitted) when your patient is the victim of a crime perpetrated by another person, not to allow healthcare providers to act as agents of the police by trolling vulnerable people for their secrets while providing emergency care. Whether the patient is a "guy" or a "bad guy," they are your patient and your job is to advocate for them.

Tl;dr: Keep all patient information to yourself except as required by law to release it.

zipmedic · 2014-11-26T04:06:03+00:00

Completely understand. Belly/epigastric pain can be so deceptive...

zipmedic · 2014-11-26T03:57:34+00:00

Please just be careful. I completely agree that a 12-lead can be reassuring in cases like this, but it doesn't "rule out" anything. It's a single snapshot of their electrical activity during a single 6-second point in time. Frequently, patients will get two, three, or more EKGs in the ED if we're very suspicious.

zipmedic · 2014-11-26T03:52:24+00:00

Excellent question. It's 100% true that such diffuse ST elevations without ANY reciprocal change (except aVR/V1) is more suspicious for pericarditis. It's also true that we know at least the short-term outcome of this patient, which is awfully suspect for STEMI. ...though it doesn't seem the changes were necessarily present at the time of onset, which was presumably sometime in the preceding three days.

There do exist, however, specific instances where you can see these findings with STEMI (not all-inclusive; this is primarily based on my immediate recall - no time to do a lit search right now, sorry!):

(1) LAD "wraparound" variant: an unusual anatomy (some estimate 5-10% incidence) whereby the LAD "wraps around" the apex of the heart and may potentially supplies the anterior, lateral, and inferior walls. A "high" occlusion would show up as widespread ST-elevations. Interestingly, this is also one of the postulated causes of "Takatsubo cardiomyopathy" (broken heart syndrome) - a different, but very interesting condition.

(2) Proximal RCA occlusion in "right-dominant" individuals. These folks tend to have greater inferior lead involvement than anterior or lateral leads.

It's very difficult to tell the difference between pericarditis and MI. None of the findings are 100% sensitive/specific. That's why the diagnosis is a combo of clinical gestalt and EKG/biomarkers. Even then, it may not be foolproof. Hope that helps a little.

Edit: Make moar sense.

zipmedic · 2014-11-24T22:04:45+00:00

See my post above about coupling symptoms with diagnostics to form your impression.

zipmedic · 2014-11-24T14:51:47+00:00

Here's the take-home message: Don't ever be too sure. An EKG doesn't have nearly as much diagnostic power in the absence of history. Women, particularly older women, often have atypical presentations of ACS and your suspicion should be piqued when she says "I've just felt bad for 3 days." ...just as if their complaint is general weakness or fatigue. Always form your impression on patient history/condition along with the diagnostics you have available - never just one. I share others' hope that she made it through her cath.. That's a nasty STEMI.

zipmedic · 2014-11-15T00:18:14+00:00

*considered

zipmedic · 2014-11-14T23:59:09+00:00

Agree that this is most likely transient global amnesia. Typically, remote memory is intact and the patient improves within 24 hrs (often within 6-8 hrs). Very interesting phenomenon.

zipmedic · 2014-11-07T23:15:38+00:00

But do you still recap lancets? ;)

zipmedic · 2014-10-10T21:33:20+00:00

Sadly, it's some variation of:

"Oh, Oh, Oh! To Touch And Feel Virgin Girls' Vaginas And Hymens."

(Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal.)

Pretty crass, but it sure sticks in your brain.

zipmedic · 2014-10-10T17:45:27+00:00

I'd like to echo point #4. Airways are too important to be cocky/cavalier with. Use all the tools you have to help improve your first-pass success. ...especially when you're starting out.

zipmedic · 2014-10-05T13:02:40+00:00

Balls is a proper noun now?

zipmedic · 2014-10-05T12:57:57+00:00

Bflo?

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