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...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 You pick your battles, and this ain't one of them. �The ignorance of one voter in a democracy impairs the security of all.� -- F. Kennedy, 1963 ----- Re: Scenario from Alyssa Date: Fri, 7 Jan 2011 13:25:53 -0600 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 that's what the LAW requires. I seem to be getting opposition to this, but hey...It's what the LAW mandates. Leave her alone, ask them to call back at anytime, if they change their minds. We will respond, and follow the same protocol. She is 18...,.it is her choice, 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 And that's what the LAW requires. I seem to be getting opposition to this, but hey...It's what the LAW mandates. Leave her alone, ask them to call back at anytime, if they change their minds. We will respond, and follow the same protocol. She is 18...,.it is her choice, 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 Cougar - I like your idea for treatment. A lot. All - The sympathetic nervous system acts in opposition to the parasympathetic nervous system - the sympathetic is fight or flight, and the parasympathetic is rest and digest. Then there is the autonomic versus the somatic nervous system. The autonomic regulates things like heart rate, respiratory rate, etc, and the somatic regulates things that we have some control over - the decision to eat spaghetti with a fork, for instance, is coordinated by the somatic nervous system. Laurie Fish - it's not schizophrenia. I think with a lot of psych cases we encounter, we jump to schizophrenia, often unnecessarily. For instance - you make a run on a guy who has come to the realization that he can bend metal. He has metal objects arranged close to him, in order of least to most metal, and other objects away from him, thrown in a corner. Is he schizophrenic? The answer is no. He has a delusion. But he does not display disorganized thought processes which one would expect with schizophrenia. He puts together complete sentences, and talks and acts unnervingly rationally - he reacts as we would react if we suddenly thought we could bend metal. Schizophrenia is a much more complex condition than most give it credit for, and I haven't even scratched the surface of it, though I encourage everyone to read up on it. It can lead to a better understanding of your patients, and put you at ease on a scene where your partner might not even be willing to enter the room (not because the condition is actually unsafe, but because some people have an irrational fear of psychiatric patients, especially schizophrenics). I apologize; I don't mean to be lecturing you, or anyone else on this list. It's just my 2 cents. Wes: Benzos are a good treatment strategy. Chris: not chronic stress disorder. She has not been raped, and is not in immediate need of CISM. Really, the best thing to do is to usher the parents out of the room and then have a little talk with her about depression. At that point, she might confide in you that she had been on antidepressants and hadn't been able to go and get a refill, leading to subsequent withdrawal. Whether she had actually decided to discontinue therapy, she had miscounted her meds, or she really had just been too busy to drop by and get them is anyone's guess, but any way you slice it, she actually was feeling quite sick, and attempting to brush off her symptoms. 200mg of Venlafaxine later, she was back to her normal, perfect little self, and a doctor's night was made a little more annoying. 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. Since I'm not sure whether to give the credit to Cougar or you collectively get a gold star and a trip to the middle of nowhere... Feel free to fight over the gold star. Congrats. If anyone feels jilted or angry, or would like to discuss how SSRI withdrawal doesn't really exist and is in fact a bunch of whiney teenagers who can't deal with their symptoms returning, go right ahead. -- Alyssa Woods, NREMT-B CPR Instructor > > > 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 In response to this, I am in possession of a RED CROSS book that teaches to punch a drowning victim in the face, to subdue them so you can rescue them. This book was published in 1958. Things change, procedures change. You'd be surprised as to what has changed over the past few years, Another reason that I need a refresher course. Coug. I'll keep my Guns, my Freedom and my MONEY, You can keep the " CHANGE. " Â >>>>> >>>>> >>>> >>>> >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 In response to this, I am in possession of a RED CROSS book that teaches to punch a drowning victim in the face, to subdue them so you can rescue them. This book was published in 1958. Things change, procedures change. You'd be surprised as to what has changed over the past few years, Another reason that I need a refresher course. Coug. I'll keep my Guns, my Freedom and my MONEY, You can keep the " CHANGE. " Â >>>>> >>>>> >>>> >>>> >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 In response to this, I am in possession of a RED CROSS book that teaches to punch a drowning victim in the face, to subdue them so you can rescue them. This book was published in 1958. Things change, procedures change. You'd be surprised as to what has changed over the past few years, Another reason that I need a refresher course. Coug. I'll keep my Guns, my Freedom and my MONEY, You can keep the " CHANGE. " Â >>>>> >>>>> >>>> >>>> >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Alyssa is right. Schizophrenia is fascinating and we do encounter them on a fairly frequent basis in EMS. There are many different disorders out there from one end to the other. Pickup a book on Abnormal Psychology or read some articles on- line some time. We tend to fear what we don't understand, when a little healthy respect and compassion for the patient may be in order. 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 Alyssa is right. Schizophrenia is fascinating and we do encounter them on a fairly frequent basis in EMS. There are many different disorders out there from one end to the other. Pickup a book on Abnormal Psychology or read some articles on- line some time. We tend to fear what we don't understand, when a little healthy respect and compassion for the patient may be in order. 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 unless the patient is on one of the adenergic blockers...central acting alpha blockers are a favorite for that problem.... ck In a message dated 01/07/11 19:22:58 Central Standard Time, wegandy1938@... writes: OH generally is self correcting as soon as the sympathetic NS kicks in and vasoconstricts. GG -----Original Message----- To: texasems-l Sent: Fri, Jan 7, 2011 6:17 pm Subject: Re: Scenario from Alyssa Haha! I suppose then that I have shown my ignorance, yet nevertheless, thank you. Alyssa Woods, NREMT-B CPR Instructor > Yes. They really are for " empty tank syndrome. > > Orthostatic Hypotension is another thing. > > GG > > Re: Scenario from Alyssa > > > > > > In response to this, I am in possession of a RED CROSS book that teaches to > > punch a drowning victim in the face, to subdue them so you can rescue them. > This > > book was published in 1958. Things change, procedures change. > > > > > > You'd be surprised as to what has changed over the past few years, > > > > > > Another reason that I need a refresher course. > > > > > > Coug. > > > > > > I'll keep my Guns, my Freedom and my MONEY, > > > You can keep the " CHANGE. " > > > > > > > > > > > > > > > >>>>> > > > > > > >>>>> > > > > > > >>>> > > > > > > >>>> > > > > > > >>>> [Non-text portions of this message have been removed] > > > > > > >>>> > > > > > > >>>> > > > > > > >>>> > > > > > > >>>> ------------------------------------ > > > > > > >>>> > > > > > > >>>> Yahoo! Groups Links > > > > > > >>>> > > > > > > >>>> > > > > > > >>>> > > > > > > >>> > > > > > > >> > > > > > > >> [Non-text portions of this message have been removed] > > > > > > >> > > > > > > >> > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 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 Always better to be judged by 12 than carried by 6 From: texasems-l [mailto:texasems-l ] On Behalf Of Sent: Friday, January 07, 2011 3:35 PM To: texasems-l Subject: Re: Scenario from Alyssa 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 Always better to be judged by 12 than carried by 6 From: texasems-l [mailto:texasems-l ] On Behalf Of Sent: Friday, January 07, 2011 3:35 PM To: texasems-l Subject: Re: Scenario from Alyssa 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 Agh!! Ok I missed that one thanks -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. >> >> >> >> >> [Non-text portions of this message have been removed] >> >> >> >> ------------------------------------ >> >> Yahoo! Groups Links >> >> >> > > > ------------------------------------ > > Yahoo! Groups Links > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Agh!! Ok I missed that one thanks -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. >> >> >> >> >> [Non-text portions of this message have been removed] >> >> >> >> ------------------------------------ >> >> Yahoo! Groups Links >> >> >> > > > ------------------------------------ > > Yahoo! Groups Links > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 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 stand 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. >> >> >> >> >> [Non-text portions of this message have been removed] >> >> >> >> ------------------------------------ >> >> Yahoo! Groups Links >> >> >> > > > ------------------------------------ > > Yahoo! Groups Links > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 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 stand 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. >> >> >> >> >> [Non-text portions of this message have been removed] >> >> >> >> ------------------------------------ >> >> Yahoo! Groups Links >> >> >> > > > ------------------------------------ > > Yahoo! Groups Links > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 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 stand 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 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 stand 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 Alyssa after reading that I don't whether to laugh or cry!!! Please don't mis interpret my post as lack of compassion, that being said I am one of the bad guys on the list that believes we as EMS are public servants whith medical training. Yes I strive to have as much knowledge as I can, but only when it pertains to prehospital medicine. I am not a psychiatrist, surgeon, or police officer for that matter, rarely do I even get a follow up on patients outcomes. I am a firm believer that EMS should embrace our lot in life and not try and be what we are not. Things like TPA out of hospital, and other uber-invasive procedures should be left to the people with more education (med-school) and more insurance. I don't have problem with medics bettering themselves with more knowledge I do, however, think it becomes a when they try and apply that knowledge where it does not belong, ie; the back of an ambulance. I defiantly respect what you are saying and maybe I mis spoke when I said we are misused by pt's. because above all we are all patient advocates (again reread lot in life comment) And compassion should be a top priority, but sometimes for us it is ok to just not know the right answer! -Chris Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > 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 stand 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 Alyssa after reading that I don't whether to laugh or cry!!! Please don't mis interpret my post as lack of compassion, that being said I am one of the bad guys on the list that believes we as EMS are public servants whith medical training. Yes I strive to have as much knowledge as I can, but only when it pertains to prehospital medicine. I am not a psychiatrist, surgeon, or police officer for that matter, rarely do I even get a follow up on patients outcomes. I am a firm believer that EMS should embrace our lot in life and not try and be what we are not. Things like TPA out of hospital, and other uber-invasive procedures should be left to the people with more education (med-school) and more insurance. I don't have problem with medics bettering themselves with more knowledge I do, however, think it becomes a when they try and apply that knowledge where it does not belong, ie; the back of an ambulance. I defiantly respect what you are saying and maybe I mis spoke when I said we are misused by pt's. because above all we are all patient advocates (again reread lot in life comment) And compassion should be a top priority, but sometimes for us it is ok to just not know the right answer! -Chris Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > 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 stand 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 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 > 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 stand 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 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 > 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 stand 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 I don't think that you are lacking in compassion at all, (hope you don't mind me using your first name). And I don't think we should be psychiatrists or surgeons or police officers or even that we should treat strokes in the field (especially since I wouldn't trust some paramedics to treat a skinned knee on a dog). And psychs can be frustrating, I understand (believe me, do I). But you know what? I can't fix the crazies. Heck, *psychiatrists* can't fix the crazies, what chance do I have, with my professors, Mr. Wikipedia, and Mr. MedScape (DDS)? But I don't have to give up on reaching them, either. And yeah... there aren't many. But every now and then... There's one. Just like, yeah... pushing that epi and starting resuscitation efforts... There aren't many that'll make it. But every now and then... You get a phone call that reminds you it's not ALL in vain. -- Alyssa Woods, NREMT-B CPR Instructor > > > Alyssa after reading that I don't whether to laugh or cry!!! Please don't > mis interpret my post as lack of compassion, that being said I am one of the > bad guys on the list that believes we as EMS are public servants whith > medical training. Yes I strive to have as much knowledge as I can, but only > when it pertains to prehospital medicine. I am not a psychiatrist, surgeon, > or police officer for that matter, rarely do I even get a follow up on > patients outcomes. I am a firm believer that EMS should embrace our lot in > life and not try and be what we are not. Things like TPA out of hospital, > and other uber-invasive procedures should be left to the people with more > education (med-school) and more insurance. I don't have problem with medics > bettering themselves with more knowledge I do, however, think it becomes a > when they try and apply that knowledge where it does not belong, ie; the > back of an ambulance. I defiantly respect what you are saying and maybe I > mis spoke when I said we are misused by pt's. because above all we are all > patient advocates (again reread lot in life comment) And compassion should > be a top priority, but sometimes for us it is ok to just not know the right > answer! > > > -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 stand 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...
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