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#186171 - 10/22/09 01:34 PM Re: Best way to clue EMTs to medical facts? [Re: James_Van_Artsdalen]
paramedicpete Offline
Pooh-Bah

Registered: 04/09/02
Posts: 1920
Loc: Frederick, Maryland
Quote:
No, I meant how often does anyone wear one. The search only succeeds if there is one to be found.

It is hard to calculate, if the patient is conscious and alert enough to answer questions, it is not generally necessary to look for a Medical Alert device, so whether they have one or not is hard to determine. If they are unconscious, the only way to know they don’t have one, is if a family member tells you that have XYor Z condition and you fail to find a Medical Alert device. It is hard to come up with a validated number, but I have encountered many diabetic, cardiac and patients with an allergy with a Medical Alert device.

Quote:
Is this an HHS standard?


The Medical Alert devices I have observed generally have a red Start of Life, medical caduceus or the staff of Asclepius, along with the medical condition(s) i.e. diabetic, cardiac, allergy.


Quote:
Breakaway chains are overrated and don't prevent incidents (useful but insufficient). ADA only requires reasonable accommodations: you don't have to create a safety hazard for it.I retired from the relevant job at ten years ago and medical necklaces never came up. It's hard to say now but had it come up I likely would have required that the card be strapped around the ankle or such, with the necklace removed while in the lab. It's the necklace that's the problem, not the card.

I work in a bacteriology lab and encounter Facility - Maintenance - Engineering staff routinely; we are all required to wear our ID badge around our necks. Some use a breakaway chain; others (myself included) use a soft-corded breakaway lanyard to address entanglement issues.

If the safety issue is from heat, using a Nomex shoelace Nomex Shoelace and a piece of shrink tubing, one could fashion a heat resistant breakaway lanyard, the dog tag could be suspended from the lanyard and worn atop a fire resistant t-shirt. If the concern is a magnetic signature, I belive Medical Alert devices are available in silver, gold, titanium and plastic.


Quote:
I may be misunderstanding what we're talking about here since the word "device" is being used: I have visions of a necklace with what amounts to a large dogtag with more text. If this is an actual _device_ of some sort that's different (and even worse given the lab EMI setting), but a necklace itself still wouldn't fly in the lab.

I may have been somewhat misleading I my use of the word device. My intention was to use the word device, simply to cover dog tag; bracelet and charm style Medical Alert items.


Pete






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#186177 - 10/22/09 03:10 PM Re: Best way to clue EMTs to medical facts? [Re: MDinana]
Jeanette_Isabelle Offline
Veteran

Registered: 11/13/06
Posts: 1578
Loc: Ocala, FL
Originally Posted By: MDinana
Jeanette, you're overthinking this. wink

Anxiety attacks are quite easy to diagnose, as a rule. Even more so if you tell the provider "Hey, I have anxiety!" or "I take Ativan!" As far as I know, no EMS agency allows their medics to give Ativan for anxiety only, so being in an acute attack wouldn't change most treatment options.

If your attack does get to the point you pass out, well, you'll have stopped hyperventilating, and likely awoken, by the time EMS arrives.

Keep in mind this was before I was diagnosed with a generalized anxiety disorder and the first time this has happened. I was at a stoplight, conveniently beside a gas station, waiting for the light to turn. My heart started beating fast followed by shallow, rapid breathing. I pulled into the station, turned off the engine and opened the door thinking whatever it was would go away on its own. It got worse. I went inside and collapsed on the floor but remained conscious. Through the shallow, heavy breathing, I did manage to indicate to the attendant that I needed an ambulance.

The ambulance arrives. I'm at least somewhat conscious with some difficulty to adequately respond. The medic checks my oxygen saturation. It was at 88%. He tells me he will put an oxygen mask on me and I nod, acknowledging I understand.

By the time I get to the emergency room, I'm fine. My oxygen saturation is back to normal. However neither the ambulance crew nor the E.R. staff figured that what I had experienced may have been an anxiety attack. I can now say, with a hindsight perspective, that it was most likely an anxiety attack.

Now if I experience those symptoms again, I know what to do. Nevertheless, would there have been a difference if the medics had a reason to believe I was experiencing an anxiety attack?

Jeanette Isabelle
_________________________
"A grain of wheat must fall to the ground before it can do any good. New life springs from fallen grain." -- Fleda Claes Johansson

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#186180 - 10/22/09 04:07 PM Re: Best way to clue EMTs to medical facts? [Re: Jeanette_Isabelle]
Jeff_M Offline
Addict

Registered: 07/18/07
Posts: 665
Loc: Northwest Florida
Originally Posted By: JeanetteIsabelle
would there have been a difference if the medics had a reason to believe I was experiencing an anxiety


No. Your treatment will be based on your symptoms and clinical findings of the medics. They (hopefully) will not just assume anxiety is the cause of the problem.

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#186195 - 10/22/09 05:46 PM Re: Best way to clue EMTs to medical facts? [Re: Jeanette_Isabelle]
paramedicpete Offline
Pooh-Bah

Registered: 04/09/02
Posts: 1920
Loc: Frederick, Maryland
This is my experience only and should not be considered definitive for you or any other individual. All novel shortness of breath (SOB) / troubled breathing (TB) events should be fully checked out and the presumptive diagnosis of respiratory or cardiac involvement must be considered until ruled out by a complete respiratory/cardiac workup. To assume SOB/TB is the result of anxiety disorder is asking for trouble.

Again, other EMS providers may have different experiences than mine, but I cannot think of a call I have had where an individual experiencing hyperventilation syndrome resulted in a lower O2 saturation. Generally, hyperventilation will “blow” off excessive CO2, since most individuals (not individuals with COPD/asthma) rely upon hypoxic drive to stimulate the desire/need to breath, without this stimulus, the body wants to slow or stop breathing, which can result in additional panic. When you hyperventilate the CO2 levels reduce and O2 levels tend to remain the same (98-100%). Decreased CO2 levels can result in respiratory alkalosis, leading to other medical issues. The signs and symptoms of hyperventilation syndrome often cause the individual to feel tingly, experience numbness in fingers, hands and feet, palpitations, cause muscle spasms and syncope (fainting).

A pulse oximeter can give a faulty reading if the patient is wearing nail polish or if blood vessels in the fingers are clamped down due to being cold. An O2 sat of 88% is pretty low for normal (non-COPD) individual and would have prodded me to consider causes other than hyperventilation syndrome.

In the old days, the individual would be asked to breath for a while in a paper bag, which would break the cycle. This practice is no longer recommended and should not be utilized. I have great success with simply calming the patient, asking them to breath with me, as I slow down my breathing, lower my voice and talk slowly, having them breath in through their mouth slowly and slowly exhale through their nose. I would say within 5 minutes most, if not all individuals experiencing hyperventilation syndrome would break the cycle.

Pete

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#186211 - 10/22/09 07:32 PM Re: Best way to clue EMTs to medical facts? [Re: paramedicpete]
Jeanette_Isabelle Offline
Veteran

Registered: 11/13/06
Posts: 1578
Loc: Ocala, FL
Originally Posted By: paramedicpete
I have great success with simply calming the patient, asking them to breath with me, as I slow down my breathing, lower my voice and talk slowly, having them breath in through their mouth slowly and slowly exhale through their nose. I would say within 5 minutes most, if not all individuals experiencing hyperventilation syndrome would break the cycle.

I learned this technique just last year at the Citizens Fire Academy. I specifically asked what is done in this situation for the obvious reason.

Originally Posted By: paramedicpete
A pulse oximeter can give a faulty reading if the patient is wearing nail polish or if blood vessels in the fingers are clamped down due to being cold. An O2 sat of 88% is pretty low for normal (non-COPD) individual and would have prodded me to consider causes other than hyperventilation syndrome.

Faulty readings from pulse oximeters are perplexing considering the warm weather (it was around spring) and, to the best of my recollection, I did not have a cold drink or handle anything cold. Of course this was seven years ago so unless I was aware of something that is significant, I most likely would have forgotten it. If fingernail polish was the cause of the faulty reading then wouldn't the pulse oximeter in the emergency room also give a faulty reading?

Anyhow, as I said, I was fine by the time we arrived at the emergency room and I have attributed that to the fact I was given oxygen on the way to the hospital.

Jeanette Isabelle


Edited by JeanetteIsabelle (10/22/09 07:42 PM)
_________________________
"A grain of wheat must fall to the ground before it can do any good. New life springs from fallen grain." -- Fleda Claes Johansson

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#186214 - 10/22/09 07:37 PM Re: Best way to clue EMTs to medical facts? [Re: paramedicpete]
Andy Offline
Enthusiast

Registered: 09/13/07
Posts: 378
Loc: SE PA
Pete,

Can I get you to be my personal emergency responder? You come across as such a professional with a great attitude towards your patients.

The leaves are pretty here in SE PA right now. And the Phillies are back in the World Series.

Think about, I know where to get some great cheesesteaks...
_________________________
In a crisis one does not rise to one's level of expectations but rather falls to one's level of training.

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#186256 - 10/23/09 02:01 AM Re: Best way to clue EMTs to medical facts? [Re: James_Van_Artsdalen]
UTAlumnus Offline
Old Hand

Registered: 03/08/03
Posts: 973
Loc: East Tennessee near Bristol
That's why any files that have to be opened (and most of the rest as I can convert them) are in effectively universal formats. Rich Text Format files will look similar on effectively any word processor. It's even readable with notepad. The text shows up with formatting added. Other than that, html, pdf, & jpg.

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#186269 - 10/23/09 05:12 AM Re: Best way to clue EMTs to medical facts? [Re: Jeanette_Isabelle]
Alan_Romania Offline
Addict

Registered: 06/29/05
Posts: 610
Loc: Arizona
Originally Posted By: JeanetteIsabelle

Faulty readings from pulse oximeters are perplexing considering the warm weather (it was around spring) and, to the best of my recollection, I did not have a cold drink or handle anything cold. Of course this was seven years ago so unless I was aware of something that is significant, I most likely would have forgotten it. If fingernail polish was the cause of the faulty reading then wouldn't the pulse oximeter in the emergency room also give a faulty reading?


Pulse Oximetry is the most over used tools in the EMS toolbox. They are finicky and sometimes just don't get a good reading regardless of perfect conditions. If I can't see a good waveform I don't trust the number they give period.

I teach my students that a pulse oximeter is a tool that should be used to see how your treatments are working not if or how you should be treating a patient.

As for anxiety attacks, I work in an area where we run more then our fair share. I have less patients then I can count on one hand where I have had to use medication to treat the patient. Usually what Pete recommends works, although some patients require a sterner approach and removing stimuli (like the 18 family members that are trying to "help" be either hugging or yelling at the patient) is helpful.

Quote:
Anyhow, as I said, I was fine by the time we arrived at the emergency room and I have attributed that to the fact I was given oxygen on the way to the hospital.


Oxygen doesn't help the typical anxiety attack, nor will it hurt. It is simply time and getting "control" over breathing that will lead to retaining normal levels of CO2 which will eventually lead to control over the feeling.
_________________________
"Trust in God --and press-check. You cannot ignore danger and call it faith." -Duke

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#186854 - 10/29/09 07:35 PM Re: Best way to clue EMTs to medical facts? [Re: Alan_Romania]
dweste Offline
Pooh-Bah

Registered: 02/16/08
Posts: 2463
Loc: Central California
Do EMTs go through your pockets in an emergency so that an EDC prominently marked card or tag would work to alert them to your conditions, etcetera?


Edited by dweste (10/29/09 07:35 PM)

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#186897 - 10/30/09 03:36 AM Re: Best way to clue EMTs to medical facts? [Re: dweste]
JohnE Offline
Addict

Registered: 06/10/08
Posts: 601
Loc: Southern Cal
Not as a rule, I'd be very wary of going thru a patient's pockets.


_________________________
JohnE

"and all the lousy little poets
comin round
tryin' to sound like Charlie Manson"

The Future/Leonard Cohen


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