Hi everyone! Most of you are already familiar with me but for those who are visiting for the first time, please allow me to introduce myself. I am a Firefighter/Medic with training and experience in the following areas; HCP-CPR, Advanced Cardiac Life Support, Prehospital Trauma Life Support, Pediatric Advanced Life Support, Firefighting Operations, Hazardous Materials, Technical Rescue, Water Rescue, Emergency Vehicle Operations, Prehospital Pharmacology, and Medical Terminology. I am here to provide technical support for those seeking to broaden their knowledge of Firefighting and Emergency Medical Services. This board has a wealth of resources to answer any and all questions that may come it's way, so if you need to know, ask and we will help in any way we can!
Search Option
by Cap
I don't know who came up with that idea but what a winner that is! Great, great idea! Makes it alot easier to find something to see if that particular question has been answered.
Wonderful tool indeed!!! Nice job!! Another reason why I think this site absolutely rocks!! Cool!!
I have a question about Valium. Can you slow push Valium? I know that it is given IV Push for seizure circumstance but can it be slow pushed if giving it as a tranquilizer? I'm thinking that's how Brackett is going to have to explain it as he gives it but I don't know if that's accurate or not. IE "We're just going to inject it slowly so that it works like it should."
IM is the preferred route for diazepam. It shouldn't be given IV ***AT ALL*** unless the circumstances are severe. Seizures warrent it. Anxiety/tranquilization doesn't.
Almost all drugs that are given IV push are given 'slow push', so the word slow is unnecessary and doctors don't use it when writing orders. It is assumed that any drug you push (with few exceptions) will be pushed slowly.
Please do not give away the RN's job to a doctor. Doctors do NOT administer medication in the hospital setting, ever. Nurses do. Nurses have training in medication administration and IV therapy that doctors don't have. By law, a nurse giving an IV push med MUST be an RN, not an LPN. Please, so many writers show doctors giving shots, etc and it just ISN'T done. Doctors won't do it and nurses won't let them. Doctors order the meds, nurses give them. Doctors don't do patient care - nurses do. Doctors write orders for care and nurses carry them through.
Thank you for your response. Makes sense. I have seen Brackett give meds many a time on E! so I thought that maybe to keep his patient (who he knows fairly well) calm, he would be the one giving the meds.
I'm not sure how I'm writing this one. I'll have to bounce it around and see what works.....:-)
Doctors only very rarely give meds, no matter what E! showed. Remember, E! was TV, not real life. They did a lot of things for 'dramatic reasons' that would never happen in a real hospital. Brackett might stand by and watch the nurse give the meds, but he's not going to do it himself - it's not his job, and he doesn't have the training needed to do it. (Although it's more likely he wouldn't even be in the room. Despite what you see on TV, most doctors don't stand around and do a lot of hand-holding. They're far too busy and they're just not interested in interacting with patients that much.)
While I agree that Emergency! was TV, and they took dramatic license, I feel that fiction based on the show may take the same license. In fact, I believe that E!Fic should remain true to the series. If one wishes to write straight medical drama, one may write for ER. Emergency! was great fun, and the fiction should be allowed to keep a certain amount of fantasy.
Then WHY have a bulletin board like this at all, if people don't want to get it right? Why ask the questions in the first place - after all, it's just fantasy. Just kill this bulletin board and base it all on the TV show, even the stuff that was bad and wrong and insulting.
Can you say 'fallacious argument'?
Call it poetic license... Call it whatever you want, I don't care, but remember that these folks want to write according to what they know from E!, and if they have no real idea about something, then they can come here for help (not berating). So what if they have a doc giving a shot... at least they care enough to sweat some of the little stuff...
Most of the time, Valium (diazepam) is given IV. Absorption via IM is variable, therefore IV is preferred. The concern with Valium is venous irritation. If a large vein is used and the med is pushed slowly, little to no local irritation should occur.
Thanks for the response! OK, then Brackett will give the shot. Now then my question becomes what would the dosage be to help someone "relax and get some rest?" We have a patient who is pretty well wound up because of their circumstances and Brackett wants to give the Valium to "take the edge off" and help him rest.
The previous poster is right - IV really isn't the preferred route for Valium -in the hospital-, with the exception of in the OR and in the ICU. Patients given IV Valium have coded - the stuff's a muscle relaxant - and it is considered too risky to give it that way to a patient that is not in a critical care area. I have checked the IV push drug protocols for two different area hospitals, (One of them's just been named one of the top hundred hospitals in the country) and neither allow it to be given that way with the exceptions of in the OR and ICU.
Ativan, on the other hand, is a better drug for 'taking the edge off' and can be given IV push easily without the risks associated with Valium. It's also more 'the drug of choice' for tranquilizing someone - it works more rapidly and effectively.
If you're going to use Valium, have it given IM. If you want the patient to get it IV, use Ativan.
Versed can be an safer, effective sedative comparable to Valium. Many pre-hospital providers seem to be going to Versed (rather than Valium) for sedation. What period in history will this story take place? Bear in mind that quite a few meds that are commonly used now, were not used or even around in the days of E!.
All of these drugs have specific uses. Ativan
is used before procedures such as cardioversion
& for seizures; however it lasts much longer than either Valium or Versed. Valium on the other hand
is used before procedures such as cardioversion,
rapid sequence intubation, relocating dislocations
& seizures. Versed on the other hand is used before
procedures & for RSI. I haven't seen any literature
showing that it is safer or more effective. Some EMS
Systems don't use it because it causes respiratory
depression.
I'm no doctor, but that last post made perfect sense.
if you remmeber your anatomy correctly, and your physiology, the HEART IS A MUSCLE. If pts. have coded using Valium IV push, well, I guess so. I does something to the heart. I'm not sure what. Someone who knows e-mail and tell me what it does, Just so those who aren't in the medical field know, and they're just writer like myself. Do lots of research
before you write, so you can get it Right. That's my advice to fanfic writers, write E! Fic. Always research. If you're going to post it, Well, some site won't take your stories if there are technical errors, they're that strict.
Dentist give shots to numb your mouth before they work on your teeth, and they're doctors. I've had a doctor
give me a shot, when I was sick with meningitis back in 1974. I was pretty embarrassed too. The same doctor deaden my back, when he removed a cysts, so sometimes doctors do give shots, but not all the time, usually, that's the nurse's job. He/she just tells the nurse what meds to give, and she carries the order out, so yes, in real life, some doctors do give shots.
The reason this particular doctor gave the shot was,
no nurse was available. My sister is a nurse, and can give shots, but she doesn't deal with patients, she's
a supervisor type person. I guess, in a pinch, where
there's no nurse available, the doctor would have to be the one to give the shot. Does that make any sense?
Usually, it is the nurse's job. The doctor just gives the order for the shot.
Off-topic a little.. Resource for Volunteer EMS Point and Reward System
by
Does anyone know of a site or other information source where I can get information on a point or other system for recognition of volunteers in Fire or EMS?
We currently only recognize ambulance hours but are looking to broaden our approach.
I have a co-worker, who suffers from Ulcerative Colitis. Today, he didn't look as if he felt very well, and I was concerned about him. I worried that he might push himself too hard, and collapse. Is there a danger of septic shock with ulcerative colitis, and how would it be treated? My nephew is a GI Doctor.
Inflammatory bowel disease (IBD) commonly refers to ulcerative colitis (UC) and Crohn's disease (CD), which are chronic inflammatory diseases of the GI tract of unknown etiology.
UC primarily involves the mucosa and the submucosa, with formation of crypt abscesses and mucosal ulceration. The mucosa typically appears granular and friable. In more severe cases, pseudopolyp formation occurs. This formation consists of areas of hyperplastic growth with swollen mucosa surrounded by inflamed mucosa with shallow ulcers. Although unusual, in severe UC, inflammation and necrosis can extend below the lamina propria to involve the submucosa and the circular and longitudinal muscles. UC arises first in the rectum, where it remains confined in about 25% of cases. In the remainder of cases, there is contiguous proximal spread. Pancolitis occurs in 10% of patients. The small intestine is never involved, except when the distal terminal ileum is inflamed in a superficial manner, referred to as backwash ileitis. Even with less than total colonic involvement, the disease is strikingly and uniformly continuous. As the disease becomes chronic, the colon becomes a rigid, foreshortened tube that lacks its usual haustral markings, leading to the "lead pipe" appearance seen on barium enema.
The quality of life generally is lower with CD than with UC, in part due to recurrences after surgery.
The most common causes of death in inflammatory bowel disease are peritonitis with sepsis, malignancy, thromboembolic disease, and complications of surgery. Toxic megacolon, one of the most dreaded complications of UC, can lead to perforation, sepsis, and death.
UC presents most commonly with bloody diarrhea. Abdominal pain and cramping, fever, and weight loss occur in more severe cases. The greater the extent of colon involved, the more likely the patient is to suffer from diarrhea. Rectal urgency or tenesmus reflects reduced compliance of the inflamed rectum. It is possible for patients to have formed stools if their disease is confined to the rectum. As the degree of inflammation increases, systemic symptoms develop. These symptoms may include low-grade fever, malaise, nausea, vomiting, sweats, toxicity and arthralgias. With severe UC, fever, dehydration, and abdominal tenderness develop, reflecting progressive inflammation into deeper layers of the colon.
IV cyclosporine is helpful in refractory UC. Hyperbaric oxygen therapy has been found helpful in the treatment of IBD that is unresponsive to other therapies. Loperamide (Imodium) and diphenoxylate are useful in mild disease to reduce the number of bowel movements and to relieve rectal urgency. The anticholinergic Bentyl may help relieve intestinal spasms. Antidiarrheal and anticholinergic medications must be avoided in acute severe disease because they may precipitate toxic megacolon. Patients with toxic megacolon initially require nasogastric suction and IV steroids. Failure to improve within 48 hours is an indication for total colectomy.
Thank, that helps, although, I don't what all those big words mean. I'm sure my nephew, Ritchie would, He's a GI doctor. Truthfully, I'm not into medicine, though I have a good background in, having members of the family, who are in the medical profession, (i.e. Nursing, GI Medicine, and Pharmacology) I've had several ancestors in Medicine, but my specialty is RETAIL! I don't pretend to know everything in medicine, because there are times when I have question, but it's nice to know, I know where to take my medical ???s
I've seen some shows, maybe not on EMERGENCY!, but maybe on some other show, the a wire shorting out, and POOF! A fire breaks out. How fast can an electrical fire burn through a structure. The fire in my story that I'm writing, well, has nothing to do with the TV show, "EMERGENCY!", but real-life firefighters at Fire Station 12. The fire is caused by two many appliances, plugged into an extension cord that causes an overload, and shorts out. I know liquid can do this, but this is a case of overload.
Just because the fire is electrical in origin, it will not burn any faster than any other type of fire. It depends on what type of construction the building is, what the fire load inside the building is, etc...For example, a wood frame house with normal furnishings will burn faster than a fire resistive construction warehouse with protection systems in place (sprinklers).
I just seemed to have seen an episode of Days, where in the middle of Vivian Alamain's lobotomy, an electrical fire broke out, and spread quickly. Laura Horton was a pt. at some sanitarium, and the people there, were bilking the Hortons of money. Those old biddies died, but Laura and Vivian were safe.
Are Fire Stations insured against arson and fire damage?
by
I'm writing a story about, well it's a fiction/reality crossover, as I have real-life FF friends at Station 12, here in LR AR. I'm a big fan of "EMERGENCY!", So is it any wonder that I dream about a fiction/reality crossover, and get this, I'm a hose jockette in the story. LOL! The story I'm writing now, a 5 alarm fire breaks out, locale unknown, but some teenage hoodlums, rob the ff's vehicles, and the station, which is left unlocked (against policy), and they set Station 12 on fire, and my dog, Jack, a Welsh Corgi/Chow mix, help apprehend them, with the help of the LR Police, and the Arson Squad. But they burn Station 12 down, because these mean kids (all boys) hate Firefighters.
So, tell me, are fire stations insured against such
things?
I apologize for repeat of question, but my e-mail kept messing up, so I wasn't sure if you got it. Anyhow, I asked Captain Floyed, at Station 12, if they had insurnace, and they said that Little Rock is automatically insured. Thank you for the answer, though.
Are Fire Stations insured against arson and fire damage?
by
I'm writing a story about, well it's a fiction/reality crossover, as I have real-life FF friends at Station 12, here in LR AR. I'm a big fan of "EMERGENCY!", So is it any wonder that I dream about a fiction/reality crossover, and get this, I'm a hose jockette in the story. LOL! The story I'm writing now, a 5 alarm fire breaks out, locale unknown, but some teenage hoodlums, rob the ff's vehicles, and the station, which is left unlocked (against policy), and they set Station 12 on fire, and my dog, Jack, a Welsh Corgi/Chow mix, help apprehend them, with the help of the LR Police, and the Arson Squad. But they burn Station 12 down, because these mean kids (all boys) hate Firefighters.
So, tell me, are fire stations insured against such
things?
Fire stations SHOULD be insured, as well as much of the equipment inside. I say 'should' because there are unfortunately, many fire departments that cannot afford the costs associated with fire insurance. Just this past year, I read several news articles describing fire departments that lost everything; the house, trucks, gear, and equipment, and they had no insurance to help cover the loss. And even sadder is the fact that a few of these fires were arson jobs.
I would imagine without a doubt that a larger city such as yours would have proper insurance coverage on all of their municipal buildings.
E-mail me if you have any other questions. I hope this helps.
The town that I work for (as a fire-medic), is self-insured. This means that they have reserves to repair or replace any damage/destruction done to town property or structures. Most metropolitan fire depts/districts usually have some type of coverage for equipment and structures. There are many smaller (mostly all-volunteer) depts out there that can't afford property insurance for equip or structures, as the liability insurance is expensive enough.
Just FYI- many government operations that are self-insured (and volly depts) also carry a policy with a very high deductible (lowers the cost) in case of catastrophicloss.
..........a "feeble" response? I have Cap in an explosion, not conscience. I wanted J & R to do a sternum rub (???? to test how far out he is) and I'm thinking once when a pt. was out on E! Brackett asked if they could get a "feeble response."
This may have been used for a subjective rating of the patient's level of consciousness meaning he/she reacted in some way. However, today many systems use the Glascow Coma Scale. If this is unreadable then try
www.nyneurosurgery.org/child/head/injury/hdinj_cs.html
Adolescents and Adults Infants and Young Children
EYE Opening
Spontaneous 4 Spontaneous 4
To voice 3 To voice 3
To pain 2 To pain 2
None 1 None 1
VERBAL
Oriented 5 Coos and babbles 5
Confused 4 Irritable cries 4
Inappropriate 3 Cries to pain 3
Incomprehensible words/sounds Moans to pain 2
2
None 1 No response 1
MOTOR
Obeys commands 6 Moves spontaneously 6 Localizes pain 5 Withdraws to touch 5
Withdraw 4 Withdraws 4
Flexion to pain 3 flexion 3
Extension to pain 2 extension 2
None 1 No response 1
NOTE: Total of the three areas is the Glasgow score.
Randy Mantooth has a new website coming up that will keep all his fans updated on his activities, projects,
charities, etc. He will be posting pictures and memoribilia from his own collection, too! The address is http://www.randymantooth.com . It's not running yet,
but should be on-line soon! Sounds great!
I'm just curious about this. I have seen several episodes of Emergency in which the victim begins to lapse into unconsciousness and Johnny or Roy attempt to keep the victim awake and alert. Why do they do this? Is this only with head injuries? Also, is it true that if you have a concussion you should keep awake? If true, why? Thanks!
With head injuries, it is important to keep the victim awake to prevent them from lapsing into a coma.
Also, the victim needs to stay alert enough to tell the paramedics or doctors if they feel any better or worse,
so proper treatment can be given and extremely critical situations can be avoided.
Many times (when I'm treating a patient), they want to close their eyes and rest while they're being transported. I try to keep them awake and have them keep their eyes open. It's much easier to keep tabs on a pt when they're awake and alert. If I let a pt rest, it's difficult to immediately notice a change in their LOC. You can also tell a lot about a pt's condition by the appearance of their eyes.
i think that they try to keep the victioms conscious so that they can find out first hand where they hurt, how they feel, etc., as it is much easier and more accurate that way
Cool!!