Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 I have actually performed the back-pressure/arm-lift method. Showing my age here. 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 Hence why I said that the " we " referred to the collective medical " we " . It was an illustration of extremely poor form to demonstrate what psychiatry as a field does (no offense to psychiatrists, and this is entirely my opinion): they think that there's a problem with serotonin, norepinephrine, dopamine, and/or monoamine oxidase, but there are times (from what I understand, many times) when they just don't know which it is. So, first they give an SSRI and when that doesn't work, they use an NSRI and when that doesn't work they use an NDRI and when that doesn't work, maybe they use an MAOI, but it's kind of case-by-case, but they never actually objectively know what any of the levels of any of these chemicals is; only the manifestation of symptoms, which could be from any or none of them. I was attempting to illustrate what would happen if we used the rules of psychology for general medicine, not to say we should use Adenosine for sinus tach, nor to say we should throw albuterol at people with high BP. Nor that you should ask someone rather than taking a blood pressure or pulse. Alyssa Woods, NREMT-B CPR Instructor > 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 Hence why I said that the " we " referred to the collective medical " we " . It was an illustration of extremely poor form to demonstrate what psychiatry as a field does (no offense to psychiatrists, and this is entirely my opinion): they think that there's a problem with serotonin, norepinephrine, dopamine, and/or monoamine oxidase, but there are times (from what I understand, many times) when they just don't know which it is. So, first they give an SSRI and when that doesn't work, they use an NSRI and when that doesn't work they use an NDRI and when that doesn't work, maybe they use an MAOI, but it's kind of case-by-case, but they never actually objectively know what any of the levels of any of these chemicals is; only the manifestation of symptoms, which could be from any or none of them. I was attempting to illustrate what would happen if we used the rules of psychology for general medicine, not to say we should use Adenosine for sinus tach, nor to say we should throw albuterol at people with high BP. Nor that you should ask someone rather than taking a blood pressure or pulse. Alyssa Woods, NREMT-B CPR Instructor > 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 Oh I know. I was just emphasizing those points for those who think there's a medication for everything and everything needs a medication. 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 Ha! Oh! On a completely different topic, have you heard that Orthostatic Vitals can't be used to determine if someone had an episode of Orthostatic Hypotension? I'm very interested about this, but all I have is hearsay. Alyssa Woods, NREMT-B CPR Instructor > I have actually performed the back-pressure/arm-lift method. > > Showing my age here. > > 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 Yes. They really are for " empty tank syndrome. Orthostatic Hypotension is another thing. GG Re: Scenario from Alyssa > > > > In response to this, I am in possession of a RED CROSS book that teaches to > punch a drowning victim in the face, to subdue them so you can rescue them. This > book was published in 1958. Things change, procedures change. > > > > You'd be surprised as to what has changed over the past few years, > > > > Another reason that I need a refresher course. > > > > Coug. > > > > I'll keep my Guns, my Freedom and my MONEY, > > You can keep the " CHANGE. " > > > > > > > > > > >>>>> > > > > >>>>> > > > > >>>> > > > > >>>> > > > > >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 Haha! I suppose then that I have shown my ignorance, yet nevertheless, thank you. Alyssa Woods, NREMT-B CPR Instructor > Yes. They really are for " empty tank syndrome. > > Orthostatic Hypotension is another thing. > > GG > > Re: Scenario from Alyssa > > > > > > In response to this, I am in possession of a RED CROSS book that teaches to > > punch a drowning victim in the face, to subdue them so you can rescue them. > This > > book was published in 1958. Things change, procedures change. > > > > > > You'd be surprised as to what has changed over the past few years, > > > > > > Another reason that I need a refresher course. > > > > > > Coug. > > > > > > I'll keep my Guns, my Freedom and my MONEY, > > > You can keep the " CHANGE. " > > > > > > > > > > > > > > > >>>>> > > > > > > >>>>> > > > > > > >>>> > > > > > > >>>> > > > > > > >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 OH generally is self correcting as soon as the sympathetic NS kicks in and vasoconstricts. 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 That's why they call it " practicing " medicine. 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 That's why they call it " practicing " medicine. 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 Chris...... For the past year, all I have done is psych transports, it is hard to tell whether they are having a good or bad day. Some days, I feel like just a baby sitter, or a taxi driver, when they appear to be normal. But sometimes things happen. Here are two examples: We took a new patient to a facility. When we got there, the patient started yelling that we had taken him to the wrong place. Now it is up to me to determine whether or not the guy is looney or what. I often have patients tell me they are not supposed to be there, when in fact they were. So....I determine his state of mind with the three questions, and feel that at the moment, he is rational....through just talking with him. AND....the staff at the facility said they didn't recognize him. My supervisor said " He's loony, just lower the stretcher and lets leave him, we have other patients waiting on us " I couldn't do that, it didn't feel right. She got mad at me. Much to my supervisor's dismay, I got on the phone and called the office, the office called the caretaker at the home health, and it turned out...we had taken him to the wrong place. On the flip side,....we often have patients that say " Where are you taking me?, I'm not supposed to be here " Sometimes they will not recognize you......all of a sudden, and start to get violent. Psych is very difficult to deal with sometimes. I have had a pt go from normal to all of a sudden... " Who the hell are you? Dont touch me! Your just a driver! I'll kill you! " .........You have to talk them down. It can be very difficult sometimes. Coug. I'll keep my Guns, my Freedom and my MONEY, You can keep the " CHANGE. " >>> >>>> 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 Silvester Method - the Tyrannomedics return! Sent from my Verizon Wireless BlackBerry 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 can have the gold star,....I want the trip to the middle of no where!! WOO HOO!!! hehehhe!! Coug. I'll keep my Guns, my Freedom and my MONEY, You can keep the " CHANGE. " > > > Does CISM really help any patients or responders?? > > > > Jim< > > > > Re: Scenario from Alyssa > > > > Would CISM help this patient? > > > > -Chris > > > > > > > > > > > > > > ------------------------------------ > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 > The great example is the patient who gets drunk. He's legally competent but due > to intoxication lacks present mental capacity. Going off topic, but this has always seemed to me to be an invalidation of Breath Alcohol Testing for DUIs. It is only done with " consent " , yet if the person is indeed drunk, then he's not competent to give consent. This is what the courts have held in rape cases, so why the double standard? Not that I'm sdvocating DUI. I don't even drink. I just love bashing the legal " system " . > I have actually performed the back-pressure/arm-lift method. Wow! I'm old enough that I was taught it in the 60s, but not old enough to have actually used it in the field! Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 She's female Bi-polar is a default diagnosis. Louis N. Molino, Sr. CET FF/NREMT/FSI/EMSI Typed by my fingers on my iPhone. Please excuse any typos. (Cell) LNMolino@... > She sounds bi-polar to me. > > But I personally cannot get past the fact that she is coherent, and has refused treatment. As a medic, that immediately shuts me down. Time to put on the counselor's hat. I would talk to her, Re-assure her that what ever is bothering her, there are people that can help. > > I don't think her condition is physically medical. I would try to talk her into going to get checked out. I would ask her if she had any thoughts of hurting herself. If she still refuses, I would have to leave, due to the refusal, but leave info with the parents of where to seek help. United Way, Continuum, MHMR, etc. I would ask them to keep an eye on her and look for indications that she may try to hurt herself. Obviously something has happened that is messing her up mentally. Only LE can act on a mental health issue. This is hard to figure out, over the computer, a personal conversation may reveal that she had been raped or something. At that point, if that was the case, I would bring in LE. > > 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 She's female Bi-polar is a default diagnosis. Louis N. Molino, Sr. CET FF/NREMT/FSI/EMSI Typed by my fingers on my iPhone. Please excuse any typos. (Cell) LNMolino@... > She sounds bi-polar to me. > > But I personally cannot get past the fact that she is coherent, and has refused treatment. As a medic, that immediately shuts me down. Time to put on the counselor's hat. I would talk to her, Re-assure her that what ever is bothering her, there are people that can help. > > I don't think her condition is physically medical. I would try to talk her into going to get checked out. I would ask her if she had any thoughts of hurting herself. If she still refuses, I would have to leave, due to the refusal, but leave info with the parents of where to seek help. United Way, Continuum, MHMR, etc. I would ask them to keep an eye on her and look for indications that she may try to hurt herself. Obviously something has happened that is messing her up mentally. Only LE can act on a mental health issue. This is hard to figure out, over the computer, a personal conversation may reveal that she had been raped or something. At that point, if that was the case, I would bring in LE. > > 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 HOLY crud.....you have the same book! 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 8, 2011 Report Share Posted January 8, 2011 Yep. I should know since I take one of them. LOL. GG Re: Scenario from Alyssa > > > > > > In response to this, I am in possession of a RED CROSS book that teaches to > > punch a drowning victim in the face, to subdue them so you can rescue them. > This > > book was published in 1958. Things change, procedures change. > > > > > > You'd be surprised as to what has changed over the past few years, > > > > > > Another reason that I need a refresher course. > > > > > > Coug. > > > > > > I'll keep my Guns, my Freedom and my MONEY, > > > You can keep the " CHANGE. " > > > > > > > > > > > > > > > >>>>> > > > > > > >>>>> > > > > > > >>>> > > > > > > >>>> > > > > > > >>>> [Non-text portions of this message have been removed] > > > > > > >>>> > > > > > > >>>> > > > > > > >>>> > > > > > > >>>> ------------------------------------ > > > > > > >>>> > > > > > > >>>> Yahoo! Groups Links > > > > > > >>>> > > > > > > >>>> > > > > > > >>>> > > > > > > >>> > > > > > > >> > > > > > > >> [Non-text portions of this message have been removed] > > > > > > >> > > > > > > >> > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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