Let's discuss when you should vs shouldn't call an ambulance

Somehow we have GOT to get the word out.  Because in one shift I received a patient via ambulance who had been having foot pain for 3 months and another patient whose family members frantically ran into the triage area asking for help to pull Dad out of the car, and when we did he was in cardiopulmonary arrest.

And why did arrest guy's family drive him in?  "At first we thought he just passed out, and we thought this would be faster."  Now, that may strictly be true, but the ambulance could have recognized that he was in distress and been giving medical interventions already.  Also?  If the moron with the 3 month foot pain wasn't calling 911, response time to CPR guy might be quicker.

Now, I fully admit that there may be times when it's legitimately hard to know whether you do or don't need an ambulance, but usually?  If you have time to discuss it?  You probably don't.

And, generally speaking, if you are under 50, never had any medical problems and take reasonably good care of yourself, there will almost never be anything wrong with you that requires an ambulance except maybe a car crash or other trauma.

It's important that you understand that saying you don't require emergency transport doesn't mean you don't need medical care.  But requiring medical care does not necessarily mean you have a medical emergency.  And far, far too many people have no concept of what is an actual medical emergency.  Anything for which you can call a Dr. and make an appointment or sit on line at an urgent care?  You should do that.  If you find yourself saying, "Well, it's just faster at the ER"?  YOU are the reason that it is actually NOT faster at the ER.   But, that's a whole other blog post...

So, lemme give you a brief lowdown  (for the legal types, I do not pretend to be the final authority nor is this list complete) of reasons for which you should ABSOLUTELY call an ambulance:

• You're just sitting there and suddenly experience excruciating chest pain that doesn't go away or is accompanied by shortness of breath or dizziness
• You're engaging in some sort of physical activity that you normally do without trouble and now developing crushing chest pain or shortness of breath
• You fell 10 ft or more, even if you think you're fine and have family who can drive you, because you need to be immobilized
• You have an allergic reaction that causes your lips to swell or feel short of breath and have hives -- ESPECIALLY if you have nut allergies, even if you just took a  hit of your epipen (Girl with nut allergy dies)
• You've cut yourself sufficiently badly that you have to hold continuous pressure to stop bleeding and so can't drive yourself and are alone
• Weakness/heaviness/numbness on one side of the body, sudden blurring or loss of vision,  inability to talk or facial droop or slurred words

And here?  Here is a list of things for which, really, you will NEVER need an ambulance:

• Foot pain for 3 months
• ANY complaint that you've have for an extended period of time 
• Any complaint that still allows you to be on the cell phone when the EMS stretcher rolls you into my ER
• If you are not having anything on the other list and there are 3 people in the house with you and 6 cars in the driveway

 In the end?  I would rather see people come in by ambulance who don't need to than have someone not call who should have.  Problem is, it's never either/or.

Strike!

Strikes have been useful tools, in the past, to hold employers' feet to the fire and ensure a safe work environment or higher wages (since the advent of organized unions, it's usually money).  Part of the reason they were effective was that it tended to be skilled laborers (coal miners) or even highly trained professionals (pilots) who were necessary and who couldn't easily be replaced. 

But I just read a story about McDonalds' staff in NYC who'd walked off the job to demand "a living wage".

Um...

I have a friend in New Hampshire who is a trained, educated paramedic who saves lives for a living and makes $1/hr more than the burger flippers are now demanding.

Do we really think that people with (potentially) NO education who LITERALLY flip burgers should get the same pay as a medic? Does anybody REALLY think that you are SUPPOSED to raise a family on minimum wage or are minimum wage jobs MEANT to be transitional, either starter jobs for kids or supplemental income for older folks?
Although, I guess Nanny Bloomberg would be happy if people stopped eating at McDonald's because burgers are now $30 to ensure that the staff gets a "living wage".
pffftt....

Look folks, it's a bad economy out there right now and there actually are people who would be happy to get paid the $7.25/hr that you are now eschewing.  You can (and in a reasonable world will) be very quickly and easily replaced.

You think getting paid minimum wage sucks?  You're right.  You hate your job flipping burgers?  You should.  You should also aspire to more and make some plans and put them into action to get out of there and into a job where you really do have value and something to offer the world.

Look into Mike Rowe's website, there is a HUGE shortage of skilled workers in this country.  Go be a plumber, carpenter, bricklayer, etc. and leave the crappy fast food jobs for the teens in high school.

Ambulance drivers and brainless butt-wipers

There was a local news story recently regarding an elderly woman who ran into an ambulance.  I happened to know the crew of that ambulance.  A couple of good medics.  The news outlet ended the story with this line, "Two ambulance drivers were uninjured." 

Reading that infuriated me.  Paramedics are highly trained (and many EMS systems now require that medics be Bachelor's prepared) and go into dangerous situations every day to save lives.  Referring to them as "ambulance drivers" demeans them.  The concept among the general public that the job of these heroes is simply to provide a ride to the hospital is probably at least part of the reason that we continue to see stories about patients and/or standers-by assaulting medics.

I actually left a comment on the online story, requesting that they correct the story and show these medics the respect they deserve.

Of course that didn't happen. 

But, as an ER nurse, I work with these folks every day and have a great deal of respect for what they do.  We are a team. 

Now, this morning, a medic friend posted this

Here's the thing.  I don't need permission.  RNs, particularly RNs in critical care areas, have a great deal of autonomy and actually, to a large extent, drive the care of our patients.  Also, the idea that medics work as total lone wolves is mistaken.  They work within protocols and actually do have to radio in occasionally for "permission" to go outside those protocols.

But, more than feeling -- initially -- anger at this dig at nurses, then disappointment at not only the medic who posted it, but other medics I know who "liked" it, I feel frustration that this ridiculous antagonism between nurses and medics helps NO ONE.  The public hears nurses berate medcs and hears medics berate nurses and they think that their disdain for both of us is justified.

Divider in chief

The ultimate weakness of violence is that it is a descending spiral,
begetting the very thing it seeks to destroy.
Instead of diminishing evil, it multiplies it.
Through violence you may murder the liar,
but you cannot murder the lie, nor establish the truth.
Through violence you may murder the hater,
but you do not murder hate.
In fact, violence merely increases hate.
So it goes.
Returning violence for violence multiplies violence,
adding deeper darkness to a night already devoid of stars.
Darkness cannot drive out darkness:
only light can do that.
Hate cannot drive out hate: only love can do that.

Dr. Martin Luther King, Jr.




This is more the kind of speech, if he had to address the Trayvon Martin/George Zimmerman case, that the president might have made.

Instead, he ratcheted racial tensions up just the one more notch.  What productive thing was accomplished by his statement a couple days ago?

Praying for this country.  Praying that our president realizes that his job is no longer that of "community organizer" but commander in chief.  Of the WHOLE country.  

Remember another great quote, Mr. President, "A house divided against itself cannot stand."

You have a constitutional right to be a jerk...and a social responsibility to, maybe, not.

I just saw someone post this on Facebook.

I really don't get all this antagonism against the police.

It's one thing to be aware of your rights and to exercise them, it's a completely different thing to set out with the idea of being a pain in the ass to the men and women who risk their lives every single day to make our lives safer.

Again, you know that, in the absence of a warrant or exigent circumstances you can refuse a search. Knowing that doesn't mean that you have an obligation to refuse a reasonable search.

There is a BALANCE between the mindless, "Well, if I'm not doing anything wrong, I don't have anything to worry about" crowd and this need to challenge the police on every little detail.  The answer to leftist administration and a complicit media is not to be as extreme as they are.  We can exercise our rights and still be responsible, reasonable people.

I have several friends and acquaintances who are cops and they are good people who actually give a damn about their communities.  Are there bad cops?  Of course, because there are bad people, but I honestly believe that the HUGE proportion of them are decent, honest people who became cops because they want to make things better.  They did not leave their houses and go to work to strip you of your constitutional rights. 

Here's an interesting thought -- statistically, probably around half of those cops are conservatives and are likely to feel just as strongly about constitutional freedoms as the people who came up with this graphic. 

So, why -- when there is NO reason (other than being a smug asshole) be a confrontational jerk?  And, trust me, the little pissant in "the video" who refused to roll down his window was just trying to be a confrontational jerk.  He wanted to make some sort of point.  The only point he made, in the end, was that he has the right to be an ass.  



This is still America. 


You have the right to be an ass.  Congratulations.  

Where there's smoke...

Are You a Closet Smoker Nurse? Don’t Apply for a New Job

Now, much as I abhor cigarette smoke -- hate having to hit my own albuterol inhaler every time I have to take care of a respiratory distress patient whose clothes are so smokey that the smell absolutely overwhelms the treatment room, and as much a I deeply resent coworkers who take multiple smoke breaks during their shift while I have a bladder that is about to explode because I can't even find time to pee -- this is ridiculous.

What someone does in their own home remains their own business.

And, what's next?  No overweight nurses?  I'm overweight.  It's a daily struggle for me.  But if a hospital (or any employer) is allowed to dictate that you may not smoke on your own time "in your own interest" what's to stop them putting BMI requirements on new hires?

Then putting GPS trackers on your car to ensure you never drive too fast.

24 hour video surveillance to ensure you wear sunscreen?

I am sick unto death of the micromanagement of every aspect of our lives.

If a nurse is competent, reliable, honest and hard-working and breaking no laws, how is that not enough?

Know what pisses me off more than a patient lying to me?

That they think I believe them.

Here's a tip:  Don't lie to your nurse.

There's not a single good reason to ever lie to your nurse.  Especially in the ER.  If you're lying for nefarious reasons (i.e., scamming for drugs), we'll probably find you out.  If you're lying because you're embarrassed,  you may be eliminating important information that may keep you safe. 

Either way, if it's easily verifiable or you just can't keep your story straight?  You're just gonna look like a moron.

Case in point:

Me (to patient who is currently text-messaging): So, if 0 is nothing and 10 is the WORST pain you have EVER felt, what number is your pain right now?

Patient (quickly glancing up at me): Oh, 10.

Me: This is the worst pain you have ever felt?

Patient: Yes.

Me: Have you had a baby?

Patient: Yeah

Me: And this is worse than your labor?

Patient: Oh, yes.

Ok.  I move on to the rest of my assessment, which, as this is a female, includes pregnancy history. 

Me: How many times have you been pregnant?

Patient: 3

Me: And how many of those did you carry to term?

Patient: None.  I've had 3 abortions.

Um...

Also, if your pain is 10/10 and you either ask for food, for the remote or how long until you get discharged?  These will all be included in your pain assessment.

But, if you do manage to convince the doc to give you narcotics and I ask (prior to administrating said narcotics) if you have someone to drive you home, do. not. lie.

If someone doesn't come to the room to walk out with you as your ride home, I have and will have security follow you to the parking lot and report your license to the police if you get behind the wheel.  I don't want my next patient to be the poor slob you crashed into.

And for the record?  I automatically don't believe any of the following:

"I was just standing around minding my own business."  (said by every single patient that was awake who had been shot, stabbed or beaten)

"I have no idea how that got in there"

"I've only had two beers"

or?

"I'm allergic to Toradol, Tramadol, Ibuprofen, Tylenol..." eventually "everything except Dilaudid" is really what you're saying. 

Whatever you have to say to the ER nurse, trust me, you are NOT the first one to say it.  Good, bad or indifferent. 

So, do us both a favor and just tell me the truth.

Zimmerman -- yeah, I'm going there

First, let me state my position on the whole thing.  I, apparently, don't really agree with anyone, entirely.  This case so quickly became about perception and politics that facts became secondary, even tertiary.  But, here they are, as I see them:


Zimmerman is a guy who wanted to feel like a badass, who is kind of a "soft, weak" (in the words of his MMA trainer) dolt who wanted to feel like a tough guy.  I think he was over zealous in his self appointed role of neighborhood Barney Fife.  I think he saw this kid, looking like a thug, walking through the neighborhood and decided to "roust" him. 

Whether Trayvon was up to shenanigans in that neighborhood is questionable.  Despite the fact that the picture that the news ran with initially was a sweet faced 12 year old, the stuff revealed from Trayvon's facebook page showed a man grown.  He was 17.  Not 12.  He was clearly more than a physical match for Zimmerman.  He did not deserve to be killed that night.

What happened?  Zimmerman followed Martin and Martin put a beatdown on Zimmerman. 

The trigger -- so to speak -- to the whole thing was Zimmerman's decision to follow Martin, despite being instructed not to.  That decision, as well as the decision to carry the gun with a round chambered and the safety off, caused the death of Trayvon Martin.  Did he have a right to carry a gun?  Yes.  But, rights come with responsibilities, and Zimmerman didn't act responsibly.

I don't think Zimmerman was guilty of murder and should never have been charged with it.  He, however, was absolutely guilty of manslaughter.  His acquittal is surprising to me, honestly.  When presented with an opportunity to convict on an appropriate charge, they still acquitted him.

I hate that this became so racialize and politicized.

This was NEVER a black/white thing.  Did Zimmerman "racially profile" Martin?  Probably, although, if Martin was wearing a hoodie, I think it at least possible that Martin didn't initally know his race.  But...Zimmerman, despite his Aryan name, is not white.  He's hispanic.  He's as hispanic as the president is black.

Race was not the issue here.  Zimmerman was a jackass no matter what his or Martin's race were.

And?  The president had no business commenting.  None. When Nixon commented on the Manson trial he was lambasted--appropriately-- for potentially affecting the outcome.  The president helped to make this case into yet another way for our country to be divided by race.

I despair that it will ever get better because there are too many people, on both sides, invested in keeping racial hatred stirred up.

But -- from here, I'm going to focus on the happy feeling I got when I read a couple of exchanges on twitter this morning that were insightful, intelligent and reasonable, even in debate, on this topic.

I'm going to hope that it's true that the change starts with me. 

Everybody gets a medal

NTSB mea culpa

I've noticed for a while that the press in this country is a joke.  But this?  This proves it.  Regardless that some dolt intern at the NTSB who happened to answer the phone that day did their best Bart Simpson impression and "confirmed" these names, how did the "reporter" not recognize these as jokes?  How did it get past what had to be multiple editors at different levels, the folks who made the graphics, the people who post the graphics, and the mindless automaton of a newsreader?

Know how?  Because everybody gets a medal.

We now have the society that was bound to be the result of a generation of people whose delicate little egos had to be protected at all cost.  Don't hold anyone to a higher standard, don't EVER tell someone they can do better, God forbid that you suggest that they SHOULD do better.  You might upset their self esteem!

So now, the people who are responsible for everything from the "news" to running our country grew up thinking life IS fair and we all get what we want when we want it.

This would also be the reason that easily 8-9/10 patients that I see list either opiates, benzodiazepines or psychotropic medications (or all of the above) in their regular medications.  No one is supposed to feel pain, ever.  Not physical, not emotional.  No one is expected to just suck it up (regardless the "it"). 

Once upon a time, it was considered character building to get past difficulties, now, you call a lawyer to sue whomever you feel is responsible for keeping you from whatever it is that you want.

We live in a Brave New World.

I'm not suggesting that it's wimpy to feel broken or hurt or feel the need for human kindness and sympathy, but I am unequivocally stating that most of the time, sucking it up really is the most beneficial, both individually and for society.  Instead of teaching children that everyone else is responsible for maintaining their self esteem, teach them that setting goals and accomplishing them -- or even learning to deal with NOT achieving them, and still moving on to another goal -- builds self esteem.

Instead of wandering about expecting to find offense, learn to recognize when the opinions of others truly don't matter.  Don't let the ignorance and hate from others make you behave ignorantly and hatefully.  And don't wander about expecting everyone around you to feel the same way you do -- about anything.

Everyone is offended.  All the time.  About everything.

Here's an idea...in the words of Don Henley? 
get over it

Oh, for Pete's sake, get a blog...

Ok.

Sounds like a plan. 

Here, I will talk about whatever I'm thinking about on a given day, at a given time and feel free to express precisely what I mean without fear that I'm doing so inappropriately.

If anybody should find themselves reading any of them and actually want to comment, that's fabulous.  Disagreement is equally fabulous, provided it's done articulately, intelligently and backed up with some facts -- unless discussing philosophical, religious or otherwise ethereal subjects, then just don't be ignorant and hateful.