74 The Final Final


(21:58) Ron goes through his final final and some skills testing. No more lectures, no more teacher’s dirty looks.

What I Did This Week


Paper work. What a pain.


Bob Page on Stethoscopes

Listener Questions

I had originally planned to contact Kelly directly, but then realized his answer would probably be useful for EMS Newbie fans as well.

Hey Kelly, I know that you’ve blogged on this topic many times and I’ve got a quick question for you. Since you’re apt to transport some rather sick (yet not entirely time sensitive) patients without lights, sirens, and guns a blazin’, do you sometimes still describe your transport as “emergent” when giving radio report to ensure the receiving staff understands that the patient is sick? It would sure be nice to trust that painting a clinical picture would be enough to alert the nurses that they should plan on placing the patient a corner or hallway, but having spent a lot of time working in the department, I fear the staff would sometimes be too busy and distracted to pick up on less overt signals. Even with a fairly obvious description, our nurses are often multi-tasking while taking radio report, and it would be very easy to assume: “The patient can’t be that sick, I didn’t hear any sirens and they’re non-emergent.” As always, thanks for the podcast,
– Vince

Hi Ron, hope you are well. I was just wondering if either you or kelly had heard of the ‘lethal triad’ with regards to trauma and whether this was something that you guys were being taught about on your course or whether you thought it should be?

Warm regards from a cold england

On the GI symptoms relating to anaphalaxis, I had heard that people with a new food allergy will often go through a progression of allergy symptoms to a certain stimulus before reaching full-blown anaphalaxis, often starting with GI symptoms. My understanding was that they would consume the food and have nausea, vomiting and/or diarrhea but not necessarily an airway issue, so it might be written off as “bad food” or stomach bug or something similar. Next time they ate that food, maybe they had worse GI symptoms but still did not connect the issue. Eventually it progresses up to true anaphalaxis with airway issues. Have y’all heard anything similar?
Andaew – Hey, In regards to stethoscope is there really a difference from a low end stethoscope and a high end stethoscope? If there is a difference how much of a difference is it and would it be worthwhile purchasing a higher quality stethoscope?
  • Vince D

    Thanks for the response; it looks like regional variability strikes again! I kinda like your setup, but in my area there’s pretty much two arrival notifications we can use: emergent vs. non-emergent. It doesn’t allow much for shades of gray, but upon reflection I still think it’s a sound concept since so much of what we do is based on the doorway diagnosis of “sick vs. not-sick.”

    Pertaining to Jamie’s question, I was rather shocked that Kelly hadn’t done a whole lecture entitled “The Lethal Triad” at some point, let alone had encountered the topic. I’m sure it’s something he’s taught but just never described as such. Speaking for our English colleague, I’ll note that in addition to listing the three factors Ron mentioned (hypothermia, hypovolemia, and coagulopathy), the concept of the lethal triad really focuses on how each piece affects the other two. Hypovolemia begets hypothermia and coagulopathy; hypothermia worsens coagulopathy and blood loss; coagulpathy leads to hemorrhage and more hypothermia.  I, for one, really like how it emphasizes a multi-faceted approach to folks losing blood and the need to correct all three problems, not just the obvious loss of red cells into the street (or, as is usually the case at my community hospital, the toilet bowl). Enjoy your Christmases gentlemen.

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