Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Sounds as reasonable as anything else. I think that the positronic brain needs adjusting. I saw them do that to Commander Data once. Wes Sent from my iPad > I got it! she is actually a robot bulit by her parents to show off, like in that movie stepford wives. The " shocks " are short circuits. It explains everything; her grades, her being a super athlete, her 50's tv family like views on sex, etc. etc...... > > I guessed it didn't I LOL!! > > -Chris > > Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > > > > You say she is athletic but how much does she weight?? > > > > -Chris > > > > > > > > Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > > > > > > >> I like the words " sympathetic nervous system " . > >> > >> The lifestyle information is important - all of it. Boyfriend, athletics, gpa, age and ability to make her own decisions... > >> > >> I mean... Doesn't she just sound like the perfect kid? How many of those do we see? Good socioeconomic background, perfect grades, notable athlete... > >> > >> Alyssa Woods, NREMT-B > >> CPR Instructor > >> > >> > >> Sent from the itty bitty keyboard on my iPhone > >> > >> > >> > >>> Ok so aside from the help establishing that she leads a healthy lifestyle, is it safe to say all the athlete talk was to throw us for a loop? Second I'm thinking lesion around her brainstem may explain tachycardia, and " anxiety attack " which may actually be an improper activation of the sympathetic nervous system? Am I anywhere even in the ballpark? > >>> > >>> -Chris > >>> > >>> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > >>> > >>> > >>> > >>> > >> > >> > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Bahahaha!! I saw that same episode it was the one where they were gonna give him emotions or something wasn't it LOL -Chris Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > Sounds as reasonable as anything else. I think that the positronic brain needs adjusting. I saw them do that to Commander Data once. > > Wes > > Sent from my iPad > > > >> I got it! she is actually a robot bulit by her parents to show off, like in that movie stepford wives. The " shocks " are short circuits. It explains everything; her grades, her being a super athlete, her 50's tv family like views on sex, etc. etc...... >> >> I guessed it didn't I LOL!! >> >> -Chris >> >> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone >> >> >> >>> You say she is athletic but how much does she weight?? >>> >>> -Chris >>> >>> >>> >>> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone >>> >>> >>> >>>> I like the words " sympathetic nervous system " . >>>> >>>> The lifestyle information is important - all of it. Boyfriend, athletics, gpa, age and ability to make her own decisions... >>>> >>>> I mean... Doesn't she just sound like the perfect kid? How many of those do we see? Good socioeconomic background, perfect grades, notable athlete... >>>> >>>> Alyssa Woods, NREMT-B >>>> CPR Instructor >>>> >>>> >>>> Sent from the itty bitty keyboard on my iPhone >>>> >>>> >>>> >>>>> Ok so aside from the help establishing that she leads a healthy lifestyle, is it safe to say all the athlete talk was to throw us for a loop? Second I'm thinking lesion around her brainstem may explain tachycardia, and " anxiety attack " which may actually be an improper activation of the sympathetic nervous system? Am I anywhere even in the ballpark? >>>>> >>>>> -Chris >>>>> >>>>> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone >>>>> >>>>> >>>>> >>>>> >>>> >>>> >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 The Sympathetic nervous system is fight or flight. Parasympathetic nervous system (from what I remember) is involuntary, such as breathing or blinking. Sympathetic is a mental reaction. Or do I have this backwards? Coug. I'll keep my Guns, my Freedom and my MONEY, You can keep the " CHANGE. " > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 The Sympathetic nervous system is fight or flight. Parasympathetic nervous system (from what I remember) is involuntary, such as breathing or blinking. Sympathetic is a mental reaction. Or do I have this backwards? Coug. I'll keep my Guns, my Freedom and my MONEY, You can keep the " CHANGE. " > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 LOL! Doesn't it just seem like that? Perfect little people... I wonder if they gave *her* emotions... Alyssa Woods, NREMT-B CPR Instructor Sent from the itty bitty keyboard on my iPhone > Bahahaha!! I saw that same episode it was the one where they were gonna give him emotions or something wasn't it LOL > > -Chris > > Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > > > > Sounds as reasonable as anything else. I think that the positronic brain needs adjusting. I saw them do that to Commander Data once. > > > > Wes > > > > Sent from my iPad > > > > > > > >> I got it! she is actually a robot bulit by her parents to show off, like in that movie stepford wives. The " shocks " are short circuits. It explains everything; her grades, her being a super athlete, her 50's tv family like views on sex, etc. etc...... > >> > >> I guessed it didn't I LOL!! > >> > >> -Chris > >> > >> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > >> > >> > >> > >>> You say she is athletic but how much does she weight?? > >>> > >>> -Chris > >>> > >>> > >>> > >>> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > >>> > >>> > >>> > >>>> I like the words " sympathetic nervous system " . > >>>> > >>>> The lifestyle information is important - all of it. Boyfriend, athletics, gpa, age and ability to make her own decisions... > >>>> > >>>> I mean... Doesn't she just sound like the perfect kid? How many of those do we see? Good socioeconomic background, perfect grades, notable athlete... > >>>> > >>>> Alyssa Woods, NREMT-B > >>>> CPR Instructor > >>>> > >>>> > >>>> Sent from the itty bitty keyboard on my iPhone > >>>> > >>>> > >>>> > >>>>> Ok so aside from the help establishing that she leads a healthy lifestyle, is it safe to say all the athlete talk was to throw us for a loop? Second I'm thinking lesion around her brainstem may explain tachycardia, and " anxiety attack " which may actually be an improper activation of the sympathetic nervous system? Am I anywhere even in the ballpark? > >>>>> > >>>>> -Chris > >>>>> > >>>>> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > >>>>> > >>>>> > >>>>> > >>>>> > >>>> > >>>> > >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Just find the switch under the rib cage and reboot... �The ignorance of one voter in a democracy impairs the security of all.� -- F. Kennedy, 1963 ----- Re: Scenario from Alyssa Date: Fri, 07 Jan 2011 12:40:57 -0600 Sounds as reasonable as anything else. I think that the positronic brain needs adjusting. I saw them do that to Commander Data once. Wes Sent from my iPad > I got it! she is actually a robot bulit by her parents to show off, like in that movie stepford wives. The " shocks " are short circuits. It explains everything; her grades, her being a super athlete, her 50's tv family like views on sex, etc. etc...... > > I guessed it didn't I LOL!! > > -Chris > > Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > > > > You say she is athletic but how much does she weight?? > > > > -Chris > > > > > > > > Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > > > > > > >> I like the words " sympathetic nervous system " . > >> > >> The lifestyle information is important - all of it. Boyfriend, athletics, gpa, age and ability to make her own decisions... > >> > >> I mean... Doesn't she just sound like the perfect kid? How many of those do we see? Good socioeconomic background, perfect grades, notable athlete... > >> > >> Alyssa Woods, NREMT-B > >> CPR Instructor > >> > >> > >> Sent from the itty bitty keyboard on my iPhone > >> > >> > >> > >>> Ok so aside from the help establishing that she leads a healthy lifestyle, is it safe to say all the athlete talk was to throw us for a loop? Second I'm thinking lesion around her brainstem may explain tachycardia, and " anxiety attack " which may actually be an improper activation of the sympathetic nervous system? Am I anywhere even in the ballpark? > >>> > >>> -Chris > >>> > >>> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > >>> > >>> > >>> > >>> > >> > >> > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 She's lost weight the last year, but she's probably about 110-120. Alyssa Woods, NREMT-B CPR Instructor Sent from the itty bitty keyboard on my iPhone > You say she is athletic but how much does she weight?? > > -Chris > > Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > > > > I like the words " sympathetic nervous system " . > > > > The lifestyle information is important - all of it. Boyfriend, athletics, gpa, age and ability to make her own decisions... > > > > I mean... Doesn't she just sound like the perfect kid? How many of those do we see? Good socioeconomic background, perfect grades, notable athlete... > > > > Alyssa Woods, NREMT-B > > CPR Instructor > > > > > > Sent from the itty bitty keyboard on my iPhone > > > > > > > >> Ok so aside from the help establishing that she leads a healthy lifestyle, is it safe to say all the athlete talk was to throw us for a loop? Second I'm thinking lesion around her brainstem may explain tachycardia, and " anxiety attack " which may actually be an improper activation of the sympathetic nervous system? Am I anywhere even in the ballpark? > >> > >> -Chris > >> > >> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > >> > >> > >> > >> > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Speaking realistically, I have no idea where we are trying to go with this scenario, but I have a plan for managing this patient. IV access, oxygen, and cardiac monitoring. I'd also discuss an order for a benzodiazepine with my medical control to lower the patient's anxiety. Additionally, the benzodiazepine would likely slow down the tachycardia and lower the slightly hypertensive blood pressure. Wes Ogilvie Sent from my iPad > She's lost weight the last year, but she's probably about 110-120. > > Alyssa Woods, NREMT-B > CPR Instructor > > > Sent from the itty bitty keyboard on my iPhone > > > > > You say she is athletic but how much does she weight?? > > > > -Chris > > > > Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > > > > > > > > I like the words " sympathetic nervous system " . > > > > > > The lifestyle information is important - all of it. Boyfriend, athletics, gpa, age and ability to make her own decisions... > > > > > > I mean... Doesn't she just sound like the perfect kid? How many of those do we see? Good socioeconomic background, perfect grades, notable athlete... > > > > > > Alyssa Woods, NREMT-B > > > CPR Instructor > > > > > > > > > Sent from the itty bitty keyboard on my iPhone > > > > > > > > > > > >> Ok so aside from the help establishing that she leads a healthy lifestyle, is it safe to say all the athlete talk was to throw us for a loop? Second I'm thinking lesion around her brainstem may explain tachycardia, and " anxiety attack " which may actually be an improper activation of the sympathetic nervous system? Am I anywhere even in the ballpark? > > >> > > >> -Chris > > >> > > >> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > >> > > >> > > >> > > >> > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Speaking realistically, I have no idea where we are trying to go with this scenario, but I have a plan for managing this patient. IV access, oxygen, and cardiac monitoring. I'd also discuss an order for a benzodiazepine with my medical control to lower the patient's anxiety. Additionally, the benzodiazepine would likely slow down the tachycardia and lower the slightly hypertensive blood pressure. Wes Ogilvie Sent from my iPad > She's lost weight the last year, but she's probably about 110-120. > > Alyssa Woods, NREMT-B > CPR Instructor > > > Sent from the itty bitty keyboard on my iPhone > > > > > You say she is athletic but how much does she weight?? > > > > -Chris > > > > Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > > > > > > > > I like the words " sympathetic nervous system " . > > > > > > The lifestyle information is important - all of it. Boyfriend, athletics, gpa, age and ability to make her own decisions... > > > > > > I mean... Doesn't she just sound like the perfect kid? How many of those do we see? Good socioeconomic background, perfect grades, notable athlete... > > > > > > Alyssa Woods, NREMT-B > > > CPR Instructor > > > > > > > > > Sent from the itty bitty keyboard on my iPhone > > > > > > > > > > > >> Ok so aside from the help establishing that she leads a healthy lifestyle, is it safe to say all the athlete talk was to throw us for a loop? Second I'm thinking lesion around her brainstem may explain tachycardia, and " anxiety attack " which may actually be an improper activation of the sympathetic nervous system? Am I anywhere even in the ballpark? > > >> > > >> -Chris > > >> > > >> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > >> > > >> > > >> > > >> > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Sympathetic controls hormones like epi and norepi it is not mental it actually manifest physically increasing heart rate berthing rate vision and metal alertness, para controls feed and breed ie; digestion, pooping (lol had to say it), release of testosterone etc. -Chris Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > The Sympathetic nervous system is fight or flight. Parasympathetic nervous system (from what I remember) is involuntary, such as breathing or blinking. > > Sympathetic is a mental reaction. Or do I have this backwards? > > Coug. > > I'll keep my Guns, my Freedom and my MONEY, > You can keep the " CHANGE. " > > > > >> > >> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Ok ask the parents to step out now what's really going on.... -Chris Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > She's lost weight the last year, but she's probably about 110-120. > > Alyssa Woods, NREMT-B > CPR Instructor > > > Sent from the itty bitty keyboard on my iPhone > > > >> You say she is athletic but how much does she weight?? >> >> -Chris >> >> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone >> >> >> >>> I like the words " sympathetic nervous system " . >>> >>> The lifestyle information is important - all of it. Boyfriend, athletics, gpa, age and ability to make her own decisions... >>> >>> I mean... Doesn't she just sound like the perfect kid? How many of those do we see? Good socioeconomic background, perfect grades, notable athlete... >>> >>> Alyssa Woods, NREMT-B >>> CPR Instructor >>> >>> >>> Sent from the itty bitty keyboard on my iPhone >>> >>> >>> >>>> Ok so aside from the help establishing that she leads a healthy lifestyle, is it safe to say all the athlete talk was to throw us for a loop? Second I'm thinking lesion around her brainstem may explain tachycardia, and " anxiety attack " which may actually be an improper activation of the sympathetic nervous system? Am I anywhere even in the ballpark? >>>> >>>> -Chris >>>> >>>> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone >>>> >>>> >>>> >>>> >>> >>> >>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Would CISM help this patient? -Chris Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > Ok ask the parents to step out now what's really going on.... > > -Chris > > > > Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > > >> She's lost weight the last year, but she's probably about 110-120. >> >> Alyssa Woods, NREMT-B >> CPR Instructor >> >> >> Sent from the itty bitty keyboard on my iPhone >> >> >> >>> You say she is athletic but how much does she weight?? >>> >>> -Chris >>> >>> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone >>> >>> >>> >>>> I like the words " sympathetic nervous system " . >>>> >>>> The lifestyle information is important - all of it. Boyfriend, athletics, gpa, age and ability to make her own decisions... >>>> >>>> I mean... Doesn't she just sound like the perfect kid? How many of those do we see? Good socioeconomic background, perfect grades, notable athlete... >>>> >>>> Alyssa Woods, NREMT-B >>>> CPR Instructor >>>> >>>> >>>> Sent from the itty bitty keyboard on my iPhone >>>> >>>> >>>> >>>>> Ok so aside from the help establishing that she leads a healthy lifestyle, is it safe to say all the athlete talk was to throw us for a loop? Second I'm thinking lesion around her brainstem may explain tachycardia, and " anxiety attack " which may actually be an improper activation of the sympathetic nervous system? Am I anywhere even in the ballpark? >>>>> >>>>> -Chris >>>>> >>>>> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone >>>>> >>>>> >>>>> >>>>> >>>> >>>> >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Would CISM help this patient? -Chris Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > Ok ask the parents to step out now what's really going on.... > > -Chris > > > > Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > > >> She's lost weight the last year, but she's probably about 110-120. >> >> Alyssa Woods, NREMT-B >> CPR Instructor >> >> >> Sent from the itty bitty keyboard on my iPhone >> >> >> >>> You say she is athletic but how much does she weight?? >>> >>> -Chris >>> >>> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone >>> >>> >>> >>>> I like the words " sympathetic nervous system " . >>>> >>>> The lifestyle information is important - all of it. Boyfriend, athletics, gpa, age and ability to make her own decisions... >>>> >>>> I mean... Doesn't she just sound like the perfect kid? How many of those do we see? Good socioeconomic background, perfect grades, notable athlete... >>>> >>>> Alyssa Woods, NREMT-B >>>> CPR Instructor >>>> >>>> >>>> Sent from the itty bitty keyboard on my iPhone >>>> >>>> >>>> >>>>> Ok so aside from the help establishing that she leads a healthy lifestyle, is it safe to say all the athlete talk was to throw us for a loop? Second I'm thinking lesion around her brainstem may explain tachycardia, and " anxiety attack " which may actually be an improper activation of the sympathetic nervous system? Am I anywhere even in the ballpark? >>>>> >>>>> -Chris >>>>> >>>>> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone >>>>> >>>>> >>>>> >>>>> >>>> >>>> >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Chronic stress disorder? -Chris Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > Ok ask the parents to step out now what's really going on.... > > -Chris > > > > Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > > >> She's lost weight the last year, but she's probably about 110-120. >> >> Alyssa Woods, NREMT-B >> CPR Instructor >> >> >> Sent from the itty bitty keyboard on my iPhone >> >> >> >>> You say she is athletic but how much does she weight?? >>> >>> -Chris >>> >>> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone >>> >>> >>> >>>> I like the words " sympathetic nervous system " . >>>> >>>> The lifestyle information is important - all of it. Boyfriend, athletics, gpa, age and ability to make her own decisions... >>>> >>>> I mean... Doesn't she just sound like the perfect kid? How many of those do we see? Good socioeconomic background, perfect grades, notable athlete... >>>> >>>> Alyssa Woods, NREMT-B >>>> CPR Instructor >>>> >>>> >>>> Sent from the itty bitty keyboard on my iPhone >>>> >>>> >>>> >>>>> Ok so aside from the help establishing that she leads a healthy lifestyle, is it safe to say all the athlete talk was to throw us for a loop? Second I'm thinking lesion around her brainstem may explain tachycardia, and " anxiety attack " which may actually be an improper activation of the sympathetic nervous system? Am I anywhere even in the ballpark? >>>>> >>>>> -Chris >>>>> >>>>> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone >>>>> >>>>> >>>>> >>>>> >>>> >>>> >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 If Sanity is defined by the delusions of the majority of the population.... then at an Insane Asylum, who's crazy- the inmates or the keepers? ck In a message dated 01/07/11 17:57:25 Central Standard Time, amwoods8644@... writes: And now I fear it is I who owe you the apology; I was calling myself crazy as a shot at myself, not as a shot at you by any means. And while I have no experience with it myself, I can imagine that even doctors find the psychiatric cases frustrating. Some of them simply crave attention (See episodes 17, 27, 33, 34, 36-47, and 58 of Oprah), and some of them just plain don't want to be helped, and those people can be really frustrating. It's really easy to see psych after psych after psych that doesn't want your help and let that cloud your vision when you get to the seventh case - that guy you might have reached. And I think that a big part of the problem is - what is sound mind? Sound mind for what? To make a medical decision? To drive? To drink? To smoke? To join the Army? To live your life normally? And what the heck is a normal life? Is it a perfect little high schooler, with perfect grades and physical condition? Or is it a burned-out medic, on his sixth coffee, with a little bit more to love, who hasn't slept in 40 hours, and still manages to work a code? If Todd is depressed and is manic and is schizophrenic and so on and so forth and we all have our own minor diagnoses... who the heck is normal? What is this mythical baseline we're trying to get all of our psych patients to? And I'm rambling, so I'll bring it all to a close with... I think that a greater understanding of psychiatric illnesses yields a better evaluation, more understanding, and ultimately... more ease of mind for yourself. And probably a smaller chance of cancer or stroke in ten years or so. Alyssa Woods, NREMT-B CPR Instructor > Alyssa, I would also like to apologize to you that was not a shot at you in the least. I was defiantly not trying to call you out as " crazy " that was a general quote from calls I have been on in the past. Please don't think I would ever pass off my patients as " crazies " that don't need my help. What I meant was our training and capabilities when a patient is in sound mind to make judgement for medical treatment or refusal limits us a great deal, when dealing with psychiatric patients which in itself is very frustrating, when and where should EMS providers draw the line. > > -Chris > > Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > On Jan 7, 2011, at 17:04, Alyssa Woods amwoods8644@...> wrote: > > > Orient yourself to the DSM-IV. > > > > Then understand the DSM-IV doesn't mean shit. (pardon the French) > > > > (It's the leading Diagnostic Manual, and it's a book full of theories.) > > > > Then understand the major neurotransmitters. (At least understand: Serotonin, Norepinephrine, Dopamine, and Monoamine Oxidase) > > > > ...And realize how little you'll use that day-to-day. > > > > Two quotes that instantly spring to mind: > > > > " Psychiatry is the only specialty that diagnosis without signs, treats without tests, and evaluates outcome without objective measurement. " > > > > and, discussing the fact that in countries where assisted suicide is legal, 93-95% of those who choose it are mentally ill: > > > > " The suffering of psychiatric patients, unlike the suffering of people with a physical illness, is usually long, drawn out, complicated, stigmatized, and with few effective treatment strategies. " > > > > > > > > Let's translate what we (the collective, medical 'we') do with psychiatric patients into a similar treatment with a common issue that we DO understand - blood pressure. > > > > You get a hypertensive patient. *ANOTHER* hypertensive patient. Everyone's rolling their eyes, and nobody wants to be there. Your partner lectures you as you drive to the call on how hypertension doesn't really exist. It's just all in people's heads, and reflects a lack of strength of character. The police officers look rather unhappy to be woken up for all this. The relatives are SO embarassed. You ask your patient what their blood pressure is. (Notice that you don't take their BP. You ask the patient, who doesn't have any medical training.) They tell you it's probably like... 200 / 150. (They're normally 150 / 100). So, you treat them with nitroglycerin. Which doesn't work. So, you think, maybe it's their heart rate. They're stressed out, so you think maybe their heart rate is at 200 (you never take their pulse, you just guess), and you treat them with adenosine. Well, that doesn't work. Ok, maybe it's their respiratory rate (you don't count, you just... ok, maybe this one is a bad > > example.). So you give them some albuterol. But they're still feeling ill, so who knows? Maybe it's just glucose or something. Or maybe it's all the crap you just shoved into their body. Or maybe you're partner was right, and they're just weak. Or maybe it's something else entirely. But that patient you had the other day perked right up with nitro. That other guy's been on a respiratory medication for seven years, without any recurrences. And they all kinda presented the same. > > > > > > > > Psychiatry is a difficult field, and I think one that not many medics give much thought to. It leads to a lot of unnecessary fear and misunderstandings with patients. If you care to contact me off-list and talk about specific calls or problems you face, I'd be more than happy to talk about " the crazies " with you. > > > > For the sake of the length of this email I shan't, however, give Alyssa's Low-Down on Every Psych Case Known To Man (including the rare Exploding Head Syndrome). > > > > > > > > But these are all just my opinions, and keep in mind... I'm crazy. > > > > > > > > > > > > Alyssa Woods, NREMT-B > > CPR Instructor > > > > > > > > > > > >> Just for the sake of discussion I have a question for the group. I have a chip on my shoulder about " psychiatric emergencies " partly due to being a magnet for them and partly due to misuse of the 911 system by both patients and law enforcement, and the bias that 99.9999% of the time psychiatric issue are non-acute. My opinion is that we (EMS) have no business being involved in these matters, unless, a medical issue arises (overdose, trauma, etc.). I honestly have been to patients that have been nuttier than bat poop, that were alert to person, place, time, and event and adamantly refused my care. Law enforcement had the attitude that " it ain't against the law to be crazy, so I can't do anything " . What then?!?!?! The family has called because the pt. Is " crazy " yet they have not threatened themselves or others. So what do we do? Refusal and pray they don't end up on top of the clock tower with a high powered rifle? I really dislike those type calls both from an ethical s tand point > > and a legal one. Ethically I truly want to help, legally I don't want to be the one on CNN explaining why I didn't get the person the help they needed when they called 911. Thoughts, opinions? > >> > >> -Chris > >> > >> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > >> > >> > >> > >>> the question came up as to when she was started on the antidepressant > >>> medications and the problems that might arise if this had happened *before* she > >>> was 18. > >>> > >>> ck > >>> > >>> > >>> In a message dated 01/07/11 15:35:06 Central Standard Time, > >>> aggiesrwe03@... writes: > >>> > >>> Ok I'm Confused, why are we arguing about whether her refusal is legal or > >>> not?? She is 18 the legal age of consent living with parents or not. On a > >>> side note punching a pt in the face during a water rescue is still being > >>> taught in swift water rescue, secondary to dunking them under the water. I > >>> think that's a rescuer safety issue. If you ask me pt. Starts drowning me > >>> with them, I'm gonna start swinging too. Better to deal with the law suit > >>> from a pt. That lived with a black eye than being on top of a fire truck in a > >>> funeral procession. Just my two cents! > >>> > >>> -Chris > >>> > >>> > >>> > >>> Sorry for the spelling and punctuation this was typed on the tiny keyboard > >>> on my iPhone > >>> > >>> > >>> > >>>> no ethical dilemma in most states...once the kids hit 16 or so, they are > >>> > >>>> allowed to seek treatment for many conditions, including, but not > >>> limited to > >>>> sexually transmitted diseases; pregnancy; drug, alcohol and nicotine > >>>> problems; sexual, psychological, physical or emotional abuse; and often > >>> psych > >>>> problems without having a parent's permission for treatment....payment > >>> is > >>>> often another story...and some of the conditions require notification > >>> of the > >>>> child welfare authorities. Speak to your medical director for more > >>>> information in your state, as they should be aware of the limitations > >>> (and should > >>>> include those limitations and exceptions in your standing orders!). > >>>> > >>>> some states allow this down to age 13 for some conditions, but require > >>>> notification of child welfare authorities much sooner. > >>>> > >>>> ck > >>>> > >>>> > >>>> In a message dated 01/07/11 13:50:11 Central Standard Time, > >>>> amwoods8644@... writes: > >>>> > >>>> The ethical dilemma to involve her parents was probably also > >>> experienced by > >>>> her PCP, but he landed on the side of treating her and allowing her her > >>>> privacy. > >>>> > >>>> > >>>> > >>>> > >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 If Sanity is defined by the delusions of the majority of the population.... then at an Insane Asylum, who's crazy- the inmates or the keepers? ck In a message dated 01/07/11 17:57:25 Central Standard Time, amwoods8644@... writes: And now I fear it is I who owe you the apology; I was calling myself crazy as a shot at myself, not as a shot at you by any means. And while I have no experience with it myself, I can imagine that even doctors find the psychiatric cases frustrating. Some of them simply crave attention (See episodes 17, 27, 33, 34, 36-47, and 58 of Oprah), and some of them just plain don't want to be helped, and those people can be really frustrating. It's really easy to see psych after psych after psych that doesn't want your help and let that cloud your vision when you get to the seventh case - that guy you might have reached. And I think that a big part of the problem is - what is sound mind? Sound mind for what? To make a medical decision? To drive? To drink? To smoke? To join the Army? To live your life normally? And what the heck is a normal life? Is it a perfect little high schooler, with perfect grades and physical condition? Or is it a burned-out medic, on his sixth coffee, with a little bit more to love, who hasn't slept in 40 hours, and still manages to work a code? If Todd is depressed and is manic and is schizophrenic and so on and so forth and we all have our own minor diagnoses... who the heck is normal? What is this mythical baseline we're trying to get all of our psych patients to? And I'm rambling, so I'll bring it all to a close with... I think that a greater understanding of psychiatric illnesses yields a better evaluation, more understanding, and ultimately... more ease of mind for yourself. And probably a smaller chance of cancer or stroke in ten years or so. Alyssa Woods, NREMT-B CPR Instructor > Alyssa, I would also like to apologize to you that was not a shot at you in the least. I was defiantly not trying to call you out as " crazy " that was a general quote from calls I have been on in the past. Please don't think I would ever pass off my patients as " crazies " that don't need my help. What I meant was our training and capabilities when a patient is in sound mind to make judgement for medical treatment or refusal limits us a great deal, when dealing with psychiatric patients which in itself is very frustrating, when and where should EMS providers draw the line. > > -Chris > > Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > On Jan 7, 2011, at 17:04, Alyssa Woods amwoods8644@...> wrote: > > > Orient yourself to the DSM-IV. > > > > Then understand the DSM-IV doesn't mean shit. (pardon the French) > > > > (It's the leading Diagnostic Manual, and it's a book full of theories.) > > > > Then understand the major neurotransmitters. (At least understand: Serotonin, Norepinephrine, Dopamine, and Monoamine Oxidase) > > > > ...And realize how little you'll use that day-to-day. > > > > Two quotes that instantly spring to mind: > > > > " Psychiatry is the only specialty that diagnosis without signs, treats without tests, and evaluates outcome without objective measurement. " > > > > and, discussing the fact that in countries where assisted suicide is legal, 93-95% of those who choose it are mentally ill: > > > > " The suffering of psychiatric patients, unlike the suffering of people with a physical illness, is usually long, drawn out, complicated, stigmatized, and with few effective treatment strategies. " > > > > > > > > Let's translate what we (the collective, medical 'we') do with psychiatric patients into a similar treatment with a common issue that we DO understand - blood pressure. > > > > You get a hypertensive patient. *ANOTHER* hypertensive patient. Everyone's rolling their eyes, and nobody wants to be there. Your partner lectures you as you drive to the call on how hypertension doesn't really exist. It's just all in people's heads, and reflects a lack of strength of character. The police officers look rather unhappy to be woken up for all this. The relatives are SO embarassed. You ask your patient what their blood pressure is. (Notice that you don't take their BP. You ask the patient, who doesn't have any medical training.) They tell you it's probably like... 200 / 150. (They're normally 150 / 100). So, you treat them with nitroglycerin. Which doesn't work. So, you think, maybe it's their heart rate. They're stressed out, so you think maybe their heart rate is at 200 (you never take their pulse, you just guess), and you treat them with adenosine. Well, that doesn't work. Ok, maybe it's their respiratory rate (you don't count, you just... ok, maybe this one is a bad > > example.). So you give them some albuterol. But they're still feeling ill, so who knows? Maybe it's just glucose or something. Or maybe it's all the crap you just shoved into their body. Or maybe you're partner was right, and they're just weak. Or maybe it's something else entirely. But that patient you had the other day perked right up with nitro. That other guy's been on a respiratory medication for seven years, without any recurrences. And they all kinda presented the same. > > > > > > > > Psychiatry is a difficult field, and I think one that not many medics give much thought to. It leads to a lot of unnecessary fear and misunderstandings with patients. If you care to contact me off-list and talk about specific calls or problems you face, I'd be more than happy to talk about " the crazies " with you. > > > > For the sake of the length of this email I shan't, however, give Alyssa's Low-Down on Every Psych Case Known To Man (including the rare Exploding Head Syndrome). > > > > > > > > But these are all just my opinions, and keep in mind... I'm crazy. > > > > > > > > > > > > Alyssa Woods, NREMT-B > > CPR Instructor > > > > > > > > > > > >> Just for the sake of discussion I have a question for the group. I have a chip on my shoulder about " psychiatric emergencies " partly due to being a magnet for them and partly due to misuse of the 911 system by both patients and law enforcement, and the bias that 99.9999% of the time psychiatric issue are non-acute. My opinion is that we (EMS) have no business being involved in these matters, unless, a medical issue arises (overdose, trauma, etc.). I honestly have been to patients that have been nuttier than bat poop, that were alert to person, place, time, and event and adamantly refused my care. Law enforcement had the attitude that " it ain't against the law to be crazy, so I can't do anything " . What then?!?!?! The family has called because the pt. Is " crazy " yet they have not threatened themselves or others. So what do we do? Refusal and pray they don't end up on top of the clock tower with a high powered rifle? I really dislike those type calls both from an ethical s tand point > > and a legal one. Ethically I truly want to help, legally I don't want to be the one on CNN explaining why I didn't get the person the help they needed when they called 911. Thoughts, opinions? > >> > >> -Chris > >> > >> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > >> > >> > >> > >>> the question came up as to when she was started on the antidepressant > >>> medications and the problems that might arise if this had happened *before* she > >>> was 18. > >>> > >>> ck > >>> > >>> > >>> In a message dated 01/07/11 15:35:06 Central Standard Time, > >>> aggiesrwe03@... writes: > >>> > >>> Ok I'm Confused, why are we arguing about whether her refusal is legal or > >>> not?? She is 18 the legal age of consent living with parents or not. On a > >>> side note punching a pt in the face during a water rescue is still being > >>> taught in swift water rescue, secondary to dunking them under the water. I > >>> think that's a rescuer safety issue. If you ask me pt. Starts drowning me > >>> with them, I'm gonna start swinging too. Better to deal with the law suit > >>> from a pt. That lived with a black eye than being on top of a fire truck in a > >>> funeral procession. Just my two cents! > >>> > >>> -Chris > >>> > >>> > >>> > >>> Sorry for the spelling and punctuation this was typed on the tiny keyboard > >>> on my iPhone > >>> > >>> > >>> > >>>> no ethical dilemma in most states...once the kids hit 16 or so, they are > >>> > >>>> allowed to seek treatment for many conditions, including, but not > >>> limited to > >>>> sexually transmitted diseases; pregnancy; drug, alcohol and nicotine > >>>> problems; sexual, psychological, physical or emotional abuse; and often > >>> psych > >>>> problems without having a parent's permission for treatment....payment > >>> is > >>>> often another story...and some of the conditions require notification > >>> of the > >>>> child welfare authorities. Speak to your medical director for more > >>>> information in your state, as they should be aware of the limitations > >>> (and should > >>>> include those limitations and exceptions in your standing orders!). > >>>> > >>>> some states allow this down to age 13 for some conditions, but require > >>>> notification of child welfare authorities much sooner. > >>>> > >>>> ck > >>>> > >>>> > >>>> In a message dated 01/07/11 13:50:11 Central Standard Time, > >>>> amwoods8644@... writes: > >>>> > >>>> The ethical dilemma to involve her parents was probably also > >>> experienced by > >>>> her PCP, but he landed on the side of treating her and allowing her her > >>>> privacy. > >>>> > >>>> > >>>> > >>>> > >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Does CISM really help any patients or responders?? Jim< Re: Scenario from Alyssa Would CISM help this patient? -Chris Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Does CISM really help any patients or responders?? Jim< Re: Scenario from Alyssa Would CISM help this patient? -Chris Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 for fear of a break off thread i'm not touching that one with a 10 foot pole lol!! -Chris > Does CISM really help any patients or responders?? > > Jim< > > Re: Scenario from Alyssa > > Would CISM help this patient? > > -Chris > > > > > > > ------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Only if the CISM team comes in via helicopter from a SSM high performance EMS system that also uses MAST trousers. You're welcome.... Wes Sent from my iPad > Does CISM really help any patients or responders?? > > Jim< > > Re: Scenario from Alyssa > > Would CISM help this patient? > > -Chris > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Um....I thought this was a question based on EMT-B not EMT--I Either way. how do you justify denying her refusal? I'll keep my Guns, my Freedom and my MONEY, You can keep the " CHANGE. " > > >> > > >> > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Um....I thought this was a question based on EMT-B not EMT--I Either way. how do you justify denying her refusal? I'll keep my Guns, my Freedom and my MONEY, You can keep the " CHANGE. " > > >> > > >> > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 What Patient? At what point does this girl get more upset since you won't just leave. I can tell you my Jersey Girl Daughter would have told you. Me and the rest of the block to leave her the #*?! alone about 20 messages ago. She's not dying in front of me, we've tried to get her to get checked out she's adamantly refusing. At some point you're in a circular motion. In the urban world and dare I say the rural one too you're wasting your resource on a person who does not want your service, she may need it but she has a right to refuse at some point she needs to be allowed to execute said right. EMS can't save the world. Louis N. Molino, Sr. CET FF/NREMT/FSI/EMSI Typed by my fingers on my iPhone. Please excuse any typos. (Cell) LNMolino@... > Speaking realistically, I have no idea where we are trying to go with this scenario, but I have a plan for managing this patient. IV access, oxygen, and cardiac monitoring. I'd also discuss an order for a benzodiazepine with my medical control to lower the patient's anxiety. Additionally, the benzodiazepine would likely slow down the tachycardia and lower the slightly hypertensive blood pressure. > > Wes Ogilvie > > Sent from my iPad > > > >> She's lost weight the last year, but she's probably about 110-120. >> >> Alyssa Woods, NREMT-B >> CPR Instructor >> >> >> Sent from the itty bitty keyboard on my iPhone >> >> >> >>> You say she is athletic but how much does she weight?? >>> >>> -Chris >>> >>> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone >>> >>> >>> >>>> I like the words " sympathetic nervous system " . >>>> >>>> The lifestyle information is important - all of it. Boyfriend, athletics, gpa, age and ability to make her own decisions... >>>> >>>> I mean... Doesn't she just sound like the perfect kid? How many of those do we see? Good socioeconomic background, perfect grades, notable athlete... >>>> >>>> Alyssa Woods, NREMT-B >>>> CPR Instructor >>>> >>>> >>>> Sent from the itty bitty keyboard on my iPhone >>>> >>>> >>>> >>>>> Ok so aside from the help establishing that she leads a healthy lifestyle, is it safe to say all the athlete talk was to throw us for a loop? Second I'm thinking lesion around her brainstem may explain tachycardia, and " anxiety attack " which may actually be an improper activation of the sympathetic nervous system? Am I anywhere even in the ballpark? >>>>> >>>>> -Chris >>>>> >>>>> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone >>>>> >>>>> >>>>> >>>>> >>>> >>>> >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 What Patient? At what point does this girl get more upset since you won't just leave. I can tell you my Jersey Girl Daughter would have told you. Me and the rest of the block to leave her the #*?! alone about 20 messages ago. She's not dying in front of me, we've tried to get her to get checked out she's adamantly refusing. At some point you're in a circular motion. In the urban world and dare I say the rural one too you're wasting your resource on a person who does not want your service, she may need it but she has a right to refuse at some point she needs to be allowed to execute said right. EMS can't save the world. Louis N. Molino, Sr. CET FF/NREMT/FSI/EMSI Typed by my fingers on my iPhone. Please excuse any typos. (Cell) LNMolino@... > Speaking realistically, I have no idea where we are trying to go with this scenario, but I have a plan for managing this patient. IV access, oxygen, and cardiac monitoring. I'd also discuss an order for a benzodiazepine with my medical control to lower the patient's anxiety. Additionally, the benzodiazepine would likely slow down the tachycardia and lower the slightly hypertensive blood pressure. > > Wes Ogilvie > > Sent from my iPad > > > >> She's lost weight the last year, but she's probably about 110-120. >> >> Alyssa Woods, NREMT-B >> CPR Instructor >> >> >> Sent from the itty bitty keyboard on my iPhone >> >> >> >>> You say she is athletic but how much does she weight?? >>> >>> -Chris >>> >>> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone >>> >>> >>> >>>> I like the words " sympathetic nervous system " . >>>> >>>> The lifestyle information is important - all of it. Boyfriend, athletics, gpa, age and ability to make her own decisions... >>>> >>>> I mean... Doesn't she just sound like the perfect kid? How many of those do we see? Good socioeconomic background, perfect grades, notable athlete... >>>> >>>> Alyssa Woods, NREMT-B >>>> CPR Instructor >>>> >>>> >>>> Sent from the itty bitty keyboard on my iPhone >>>> >>>> >>>> >>>>> Ok so aside from the help establishing that she leads a healthy lifestyle, is it safe to say all the athlete talk was to throw us for a loop? Second I'm thinking lesion around her brainstem may explain tachycardia, and " anxiety attack " which may actually be an improper activation of the sympathetic nervous system? Am I anywhere even in the ballpark? >>>>> >>>>> -Chris >>>>> >>>>> Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone >>>>> >>>>> >>>>> >>>>> >>>> >>>> >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 and uses verapamil �The ignorance of one voter in a democracy impairs the security of all.� -- F. Kennedy, 1963 ----- Re: Scenario from Alyssa > > Would CISM help this patient? > > -Chris > > Quote Link to comment Share on other sites More sharing options...
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