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...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 I agree whole heartadly, in fact after ten years as a basic and now six months as a paramedic I received (well my partner actually) my first call from a cardiac arrest survivor that I worked on. It's hard to explain how good that makes you feel especially when you go years feeling like the nights of cold rain and missing holidays are in vain. I have always told my students that it is an honor to be with patients as they die, but it's even more of one when they call you and tell you you are the reason they didn't. That was a crappy shift had my first code as a P which was a very young child, 20 mins later I had my second code as a P, he survived.... P.s. You are most certainly welcome to use my name! lol -Chris Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > 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...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 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 > > > > > 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 Lol very well said!! -Chris Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > 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 >> >> >> >>> 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 Lol very well said!! -Chris Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > 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 >> >> >> >>> 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 In the land of the blind, the man with visual hallucinations is King... Alyssa Woods, NREMT-B CPR Instructor > 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 > > > > > > > > > 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 In the land of the blind, the man with visual hallucinations is King... Alyssa Woods, NREMT-B CPR Instructor > 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 > > > > > > > > > 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 Mike, Mental capacity and mental competence are two different things. One is presumed to be mentally competent until proved incompetent in court and the judge or jury has made the declaration. On the other hand, one can be mentally competent legally but still lack present mental capacity to refuse treatment. In case of lack of present mental capacity the patient may be treated under implied consent. Texas has a specific statute in Chapter 773 that covers that. However, even if there were no statute, one can treat under implied consent under common law. The great example is the patient who gets drunk. He's legally competent but due to intoxication lacks present mental capacity. Ditto with the head injured patient with a GCS of 12, and so forth. The classic test for present mental capacity is Folstein's Mini Mental Status test. Gene Re: Scenario from Alyssa As far as I know, her current living arrangements should not make a difference. However, you do bring a good point about mental status. But I think that would have to be declared by a court, if her civil liberties are to be taken away. I would think. Coug. I'll keep my Guns, my Freedom and my MONEY, You can keep the " CHANGE. " > You guys are all missing the basics. You are skipping to the diagnosis, And most of you are coming up with WONDERFUL ideas of treatment. But remember. the girl is 18 years old, and refusing to be treated. If you even TOUCH her after that, you could be charged with assault. > > Coming up with what could be wrong, is admirable, but don't let go of our EMT basic training. She is 18 and said " Go Away " . > > ANY patient then can pass a basic mental exam.... > > Who is the President? > > What year is it?.....etc.... > > CANNOT be treated, if they refuse, and they are conscious. > > I hate the " what day is it? questions, cause sometimes " I " don't even know what day it is!! :) > > 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 CISM helps NOBODY! GG Re: Scenario from Alyssa 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 And boards everyone according to mechanism of injury and flies them to the Level I even if they show no signs of injury at all. And places bilateral traction splints for good measure. GG 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 WHAT? You mean I bought that SuperMedic cape for nothing? GG Re: Scenario from Alyssa 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 Yes, and if you could please change out of the Spandex, we'd all appreciate it. .... I thought I was getting more psych calls than usual! Alyssa Woods, NREMT-B CPR Instructor > WHAT? You mean I bought that SuperMedic cape for nothing? > > GG > > Re: Scenario from Alyssa > > 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 Right Steve. Schizophrenia is fascinating. The voices coming out of the toaster told me that. GG 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 Right Steve. Schizophrenia is fascinating. The voices coming out of the toaster told me that. GG 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 If she can pass Folstein's you take a refusal from her. If she can't treat under implied consent. GG Re: Scenario from Alyssa 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 If she can pass Folstein's you take a refusal from her. If she can't treat under implied consent. GG Re: Scenario from Alyssa 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 Also, if they're seizing, knock their front teeth out and put a safety pin through their tongue so they won't swallow it. 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. " >>>>> >>>>> >>>> >>>> >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Also, if they're seizing, knock their front teeth out and put a safety pin through their tongue so they won't swallow it. 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. " >>>>> >>>>> >>>> >>>> >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Don't forget to turn them face-down before initiating CPR! Alyssa Woods, NREMT-B CPR Instructor > Also, if they're seizing, knock their front teeth out and put a safety pin through their tongue so they won't swallow it. > > 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. " > > > > > >>>>> > > >>>>> > > >>>> > > >>>> > > >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 1. We do not treat hypertension in the field unless a hypertensive emergency exists, which means that end organ damage is occurring. That seldom happens. 2. We do not give adenosine to patients in sinus tachycardia. 3. We don't give albuterol unless they have acute reactive airway disease. 4. We don't give glucose unless there's a reason for it. 5. We treat mentally ill patients if they are an immediate danger to themselves or others. If they refuse, we get law enforcement to confine them under the Code section that permits that. If they are no danger, and they can pass the present mental capacity test, we leave them alone. GG Re: Scenario from Alyssa 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 stan d 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 1. We do not treat hypertension in the field unless a hypertensive emergency exists, which means that end organ damage is occurring. That seldom happens. 2. We do not give adenosine to patients in sinus tachycardia. 3. We don't give albuterol unless they have acute reactive airway disease. 4. We don't give glucose unless there's a reason for it. 5. We treat mentally ill patients if they are an immediate danger to themselves or others. If they refuse, we get law enforcement to confine them under the Code section that permits that. If they are no danger, and they can pass the present mental capacity test, we leave them alone. GG Re: Scenario from Alyssa 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 stan d 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 Sometimes its better to " Don't just do something. Stand there! " G Re: Scenario from Alyssa 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 spok e 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 Sometimes its better to " Don't just do something. Stand there! " G Re: Scenario from Alyssa 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 spok e 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 Yup that's what I believe -Chris Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > > > Sometimes its better to " Don't just do something. Stand there! " > > > G > > > > > > Re: Scenario from Alyssa > > > > > > 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 spok e 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 Yup that's what I believe -Chris Sorry for the spelling and punctuation this was typed on the tiny keyboard on my iPhone > > > > Sometimes its better to " Don't just do something. Stand there! " > > > G > > > > > > Re: Scenario from Alyssa > > > > > > 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 spok e 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...
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