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A young paramedic, who works for a different agency within the system, but we share a common medical director, came to me this week and wanted to confirm that he was correct in arguing with his supervisor on a certain medical issue. It seems that he ran a call on a woman who was complaining of vertigo and shortness of breath. He found a weak radial pulse, and the monitor (ECG) showed a sinus rhythm at a rate of 86, and her BP was 84/50. Our young medic started a line, and was preparing to give some fluids, and that is where the trouble began.

The supervisor that was on scene felt for a radial pulse, and got a pulse of 36. He insisted that this meant that the patient was bradycardic, and that the young medic administer atropine. The medic refused, and an argument ensued. Our young medic was instructed to “treat the patient and not the monitor” and ordered again to give the atropine. Young medic refused. After the call, our young medic friend was written up for insubordination and failure to follow orders, and sent to see the QA department. The QA department SIDED WITH THE SUPERVISOR, and now the medic faces a discipline hearing, where he is likely to get suspended. The woman from QA told him not to depend on the monitor, as she has seen a Lifepack get a BP and an O2 sat from a mannequin.

So he came to me, and asking for my take, and I gave my opinion. For those who may not know, here it is: The reason for the discrepancy between the patient’s pulse and the rhythm on the ECG was caused by blood pressure. It takes a systolic blood pressure of about 80-90 for a person to have a palpable radial pulse. Since the patient’s BP was so close to 80, it is likely that some pulses were reaching that threshold, while others were not. Since the monitor showed a heart rate of 86, giving Atropine would not have corrected the issue, as this was likely a fluid issue, or perhaps even a problem with vascular tone. In either case, the appropriate treatment would have been fluids, and if that failed, Dopamine should be considered. I told the medic that he should get the Medical Director involved, and get him to come to the discipline hearing if possible.

I am really starting to become convinced that there are very few competent people working anywhere in our health care system. That includes everyone from medics and nurses to the doctors. I am not sure where these idiots come from, or how they manage to pass the state test, but they are out there, and they actually get promoted to positions of power. Unbelievable.

The Second Amendment covers ARMS. That means all of them- machine guns, grenades, artillery, jet fighters, naval warships, and yes, even nukes.

If you disagree that the 2A includes nukes, you don’t simply redefine the words of the COTUS, that is the same thing that the Brady bunch does now. The founders had a method for changing the Constitution: the Amendment process. I am sure that 3/4 of the state legislatures would have no problem passing an Amendment that exempts nuclear weapons from the Constitutional definition of arms.

DiGiorno’s pizza recently announced that they will be packaging a frozen pizza in the same box with a batch of cookie dough. You can have pizza and freshly baked cookies for dinner. What a great idea.

Of course, the nanny media is already bitching about how companies are making us fat by producing articles that we will buy, instead of producin what we SHOULD be eating, if only we were smart enough. The typical complaints about how it is bad for your health to eat pizza and cookies, and how companies should be offering healthier alternatives are heard.

Look, the grocery store offers healthy alternatives. I was just shopping today, and there were sections of the store that contained vegetables and all sorts of healthy stuff. Don’t like pizza and cookies? Then don’t buy them.

I will tell you that my brother owns a vending machine business, and he is constantly asked to carry healthy snacks. Every time he puts healthy snacks in a machine, they do not sell. The people counter that it is his fault, because he puts junk food in there WITH the healthy snacks, and people cannot make the healthy choice when there is junk food there as well.

The problem is obvious to these people- we have too much freedom for our own good.

You have to admire the Democrats for one thing: They know how to get stuff done. When they had control of the Congress and Whitehouse, they rammed through the Health Care law without even bothering to read it. When they do not have control, they browbeat the Republicans into submission by screaming about the need to be “bipartisan” and the Republicans cave.

When that doesn’t work, they attach amendments to bills at the last minute, and those amendments sneak through laws that would not normally pass. The Executive signs orders that have the effect of law, thus bypassing Congress, on laws that would normally not see the light of day.

They lie, they cheat, they steal their way to power. This is the reason why the founders intended to limit the extent of the power of the Federal Government.

I just read a column by Walter Williams, the man that I would like to see in the Whitehouse, and I love a couple of the quotes from it:

“A Constitution of Government once changed from Freedom, can never be restored. Liberty, once lost, is lost forever.”- John Adams

“Congress has not unlimited powers to provide for the general welfare, but only those specifically enumerated.” – Thomas Jefferson

“With respect to the two words ‘general welfare,’ I have always regarded them as qualified by the detail of powers connected with them. To take them in a literal and unlimited sense would be a metamorphosis of the Constitution into a character which there is a host of proofs was not contemplated by its creators.” – James Madison

But what do those guys know, they are old white men who lived over 100 years ago, don’t you know.

You’ve heard of no fly and no buy lists – get ready for no work lists. Millions of workers now must apply to the DHS and prove they are not terrorists in order to be granted permission by the government to work. 

The new DHS programs, called TWIC and SWACwill expand the TSA no fly list to be applied to a “no work” list. This means that once you are on the “no fly ” list, a list you get on without being told why, and without recourse to be removed, you can not get a job in any worksite that the government deems “vital.”

What happened to due process? Jury trial? Seriously, is this for real. or is infowars a conspiracy theory kook site? Anyone?

UPDATE: They may be pulling the trigger prematurely. Here is the list of crimes you can be denied for. Looks like a standard background check to me.

I know people who are bragging that they are getting back large refunds. I know one person who brags that he is getting back $8,000. During the discussion, another claimed that her and her husband are getting $14,000. I was incredulous. That money is not free- it means that you had too much money taken out of your checks throughout the year. If you file your taxes, and you are getting back 14 grand, that means that you could have $1,100 a month more in your pocket every month.

What gets me is that these people probably have a couple of maxed out credit cards, and could be using that money each month to pay off the 20% interest rate cards.

This year, I will owe $350 or so. That is as close as I can figure them when I set my W4 exemptions each month.

All paramedics go through it. You medics know what I mean. I once went through a period in my career in which I was called a nickname: “Doctor Death.” In a 24 week span, I worked 29 codes. In only one of those codes did I get pulses back, and that patient died two days after I took them to the hospital. The oldest of those dead patients was 102 years old, and the youngest was 6 months old. Also in that 24 week period, I had trauma alert patients, STEMI patients, and all sorts of odd events. One of the Doctors at the hospital asked me in jest if I ever got tired of my patients dying all the time, and I responded with a joke about how my laryngoscope was a deadly weapon.

You need a sense of humor in this profession, or you will soon burn out and leave, as so many who wear their hearts on their sleeves do. You wear that sense of humor, as odd as it becomes, like a suit of armor. That is the protection that you need if you are to survive the sights of hundreds of dead bodies. Trust me, that number is well into the hundreds. There was an incident several years ago where I triaged bodies, and personally decided that 31 people were dead in less time than it took me to write this post.

In essence, triage is a lot like playing god. You decide who will live, and who will die. The decisions that you make on every call will affect people for the rest of their lives. I have welcomed newborn babies into the world, and I have held the hands of people as they left this world. Every one of these decisions were made with relatively little oversight, and a whole lot of latitude as to how I come to that decision. It is a position of trust that I do not take lightly.

With all of that trust, the background check that I had to endure was not nearly as thorough as the one that was done when I got a concealed weapons permit. Ask yourself why people who feel that I am trustworthy enough to give potentially lethal medications and make life or death decisions as a paramedic feel that I am not trustworthy enough to carry my defensive weapon to class when I am attending college.