Hi everyone,

I wanted to see how much of a difference acoustic design actually makes, so I tested the frequency transmission of a few stethoscopes I had on hand.

Setup & Limitations: I ran frequency sweeps from low bass up to ~3 kHz. Keep in mind that this is a DIY acoustic test bench: above 3 kHz, acoustic coupling and reflections make the setup less stable, but the range below 3 kHz covers the clinically relevant spectrum for heart and lung sounds anyway (S1/S2, murmurs, breath sounds). Every measurement was taken twice and both lines are plotted, so in the overlapping part they are very reproducible.

Graph:

• In the first graph (big membrane), the blue line is the no-name Rappaport, the red line is the MDF 747, the green line is the LuxaMed Sonus SX, and the yellow line is the MDF MD One.
• In the second graph (bell), the light blue is the LuxaMed, the dark blue is the MDF 747, and the violet is the MDF MD One.

A few interesting takeaways from the data:

• There seems to be no very big difference in frequency response between membrane side and bell side.
• All of them performed pretty similarly; however, the no-name one performed best, which was kind of surprising.
• Subjectively, the biggest difference was in noise reduction from the surrounding background noise; there the MDF MD One was best, followed by the LuxaMed, then the other MDF, and the no-name didn't reduce it at all.

Conclusion: I was really surprised to see the MDF MD One in last place in both measurements. I was pretty sure it would outperform all the others, but as far as I tested, the best bang for the buck (also considering sound insulation) is the LuxaMed. I also added some memory foam ear tips, which improve sound isolation even more, and with that mod it outperforms the MD One easily.

Questions for you:

1. Did I misinterpret the results, or do you have any other idea why the MDF MD One underperformed that badly?
2. Which stethoscopes would you like to see measured next?
3. What is your daily driver in the field/hospital, and what sound profile do you actually need in your specialty (med student, resident, attending, nurse, or paramedic)?

Curious to hear your thoughts!

Dispatched to a 32 year old male chest pain fifteen minutes before end of shift. Got on scene and patient was diaphoretic and pale laying on steps clutching his chest. Stated it was a sudden onset and that his left jaw was killing him. Got this 12 lead before we loaded him up. Based on presentation, the presence of some elevation even though he didn’t have reciprocal depression and my butthole was starting to clench ended up called in a STEMI alert. Unfortunately air was unable to fly so had to ground pound it 1:30 hours to nearest PCI facility. Started a nitro drip at 20mcg/min and bolused 4500units of heparin. Immediate relief with nitro drip which was titrated up to 100mcg/min over the course of transport along with 50mcg of fentanyl every 20 minutes. Got him to the cath lab and ended up with a 90% LAD occlusion at only 32 years old.

So we had a very odd code today, and it's sort of two-fold...

70 y/o male, HX of diabetes and recent cancer remission (didn't catch what type of cancer). Had his last chemo treatment today. Takes insulin and Eliquis.

Dispatched as chest pain and sudden severe SOB. While enroute, advised CPR in progress. Obviously witnessed, bystander and cop started compressions immediately. Pt is purple from the nipple line up, all S/S points to probable PE. Apneic (agonal at least), and no pulse....

We take over compressions, apply AED (we're a BLS Fire Dept., I'm FF/AEMT, should've mentioned that) and I begin prep for airway and IV access. Here's where it gets interesting...

After about a minute and a half of compressions, the guy opens his eyes, starts trying to talk, and we have ROSC. Carotid pulse and even a weak radial pulse, and he's fairly well conscious at this point. BUT, the AED is still attached and analyzing, and advises SHOCK, while this man is starting to talk to us. Kinda weird right?

Ambulance arrives, monitor goes on and this man's vitals are near perfect. Monitor shows RBBB, and maybe a slow VT, but nothing that really jumps out. No cardiac HX either.

So my question(s)...was it a PE, or maybe a run of VT that put this guy down? Say it WAS a PE, could compressions dislodge an embolus to the point it is no longer obstructive?

And why would an AED advise SHOCK on a conscious and awake patient? Malfunction or actually detecting a shockable rhythm?

14 years doing this and I've never seen an AED do that. I'd love to hear the thoughts of people smarter than me, haha

Was first on scene to a collision between to e-bikes on my way home from work. Ironically I’m a bicycle mechanic in my day job. Ski patroller when not working on shitty e-bikes. One rider was up and yelling to call for help. Second rider was motionless. Pulled over, grabbed my first aid kit. Patient was laying prone with his head turned to the side. Multiple facial lacerations, skull visible through laceration on his head. Bleeding from nose and mouth. Was able to clear his nose and mouth enough to get labored breathing. Since blood was running out of his mouth I didn’t want to roll him as I was on my own without any method to provide suction or supplement breathing and was worried he’d aspirate. Another witness had 911 dispatch on the phone and we were only a couple minutes from multiple staging locations for our ALS provider. Found his wallet and got his name from his ID and started talking to him. Still GCS of 3. By the time I was thinking I should drop an NPA the FD arrived on scene and took control. Paramedics were just behind. He was still unresponsive but the time they were loading him in the bus. They’d intubated and were bagging.

I know I’m not in the chain of people who can get an update on his status. Already tried sweet talking the ED phone receptionist. But it sucks to not know if he is still holding on or not. We send a lot of patients to the same hospital during the winter so I’m going to see if my patrol director can reach out through the channels we typically use for updates.

I also ended up doing a witness statement for PD as I saw the collision. Hoping if I can’t get anything from our medical channels PD can at least till me basic condition of the dude.

His face after they flipped him is definitely ending up in the memories I wish I didn’t have file.

And please wear a helmet.

IFT EMT, there were two situations I was curious about from a HIPAA/professional boundaries standpoint. I’m not planning on doing either just curious!!

1). An old lady at an SNF used to teach Vietnamese and offered to teach me in her free time after i said i always wanted to learn, she then gave me a note with her number. Would it be a HIPAA violation to text her?

2). old lady mentioned feeling lonely and missing her family. Would it be inappropriate or against any rules to send her flowers to the SNF?

Hi!

I've been a modder for Cyberpunk 2077 for a while now, and I think this might be my most daunting project yet.

I decided to make an emergency version of the Militech Behemoth (a truck in Cyberpunk 2077, it's in the image list) and I've reached the part where I make it a mobile intensive care unit. I've taken inspiration from mobile stroke units, mass casualty ambulances, ECMO vehicles..

I'm still trying to get the layout in order, so here's what I have right now:

- The Behemoth has a container on the back that cannot pass through to the front (because there's an engine compartment in between). There are no access doors except a ramp on the back.

- The forward half, up to the wall of the container, is (I envision) a surgical suite, including a robotic surgical system (of my design) and a compact CT scanner.

- The rear half (where the chairs are) will likely include paramedic seating, space for one stretcher for a patient that needs to be monitored, possibly a field lab machine, and a control station for the doctor.

I'm already thinking about where to place the IV, oxygen distribution system, possibly an X-ray machine...

How would you organize this truck, r/EMS?

(Please, I'm admittedly somewhat lost.)

I live in a town with 225,000 people and average probably 6-11 calls in 12 hours, but only go emergent to the hospital (at least recently) like every 4-5 shifts. Honestly think I’ve gone emergent twice in the last 30 days. I am very much a white cloud but wonder if bigger cities create more frequent higher acuity calls. My system is ALS only

Good evening, fellow psychopaths.

I'm a paramedic in a busy urban/rural system that seems to have an abundance of constantly trying to die patients. I love my job; it's challenging and, frankly, fun. We're kept busy with transports ranging from 15-60 minutes and have a pretty good scope. We primarily transport to one local hospital and a few outlying hospitals outside of our district. Here's the meat and potatahs of this discussion, though:

Do y'all treat while waiting for a room at the hospital?

The local hospital where I work is pretty good, but they're very busy for their size. The next closest hospital is aprox 30 min away, and it's a step down, just as the next two are. The closest big, really good hospital is an hour drive away. This means they're BUSY, and they get a lot of sickie sickertons boarding in the ED.

We're taking patients to this place and holding the wall for at least 30 minutes if we don't get a room immediately. I've waited several hours before; and these aren't BS patients either! I had a patient wait 30 minutes on BiPAP with CHF/Pulmonary Edema a shift or two ago. I've had septic patients, patients I've given multiple doses of antiarrhythmics to, and more (all within the past WEEK) who I've had to wait at the back door for over 30 minutes. I waited over 2.5 hours with a patient overdosing on cocaine and fentanyl who I had to constantly stimulate to keep awake otherwise he'd stop breathing after 4mg of IV Narcan (which is as much as we carry).

These patient's don't pause getting sick at the hospital until they're ready; they get worse! They'll desat, their mental status decreases, or they need a redose on analgesia or another DuoNeb. Not treating these patients is not an option most of the time. The opinion of my supervisor is to dump them in front of charge and refuse to treat them without a doctor's orders. When I talk to a doctor they basically just agree to whatever I say my protocol is, but that still takes like 10-15 minutes of me, the sole ALS provider, walking away from my patient.

So what do y'all do? I know I have nothing on agencies in other countries (I'm in the USA) waiting an entire shift for a room, and I know there are plenty agencies in the stars and stripes land that wait longer on the daily; surely y'all have some recommendations.

I have a newish coworker get caught using AI to write her charts. Apparently she uses Chat GPT to put the general information to generate her narrative and then copy and paste it into the narrative section of our charting system. She was talked to about this during her training period and seemed to stop for a while but has started again. My work does not have a policy for AI charting but I feel like this is still concerning. Putting my feelings for AI aside, I feel like this could potentially be a HIPPA violation (as far as I understand she doesnt put patients name or address, but things like age, gender, and what ER room they were delivered to end up in these narratives). I feel like this is also a nightmare for legal. If she gets a subpoena how does she explain a chart she didnt write? Anyone else have an experience like this? Thoughts?

Hi Folks of EMS. Ive worked at a 911 only service for 1.5 years. I did around 9 months as a volunteer then became a per diem staff member.

We got dispatched to a nearby town for an MVA w/ 1 pt. I was driving and approached exactly where we were dispatched to which was the side of a busy road. PD instructed me to go to the parking lot of thr PD station as that's where the pt was.

I drive 30 seconds down the street to the PD station. I turn into the back parking lot (which is NOT illuminated by any means) and there's a cop cruiser in the middle of the driveway, and 2 other to the right. I pull into the left hand side and clear the cop cruiser in the middle. We have the big box type ambulances, which ive never had an issue driving (at all, I even prefer them to the van style that we have at my other service.) I did have my emergency lights on, and as Im driving down the right rear wheel flare snags the left front fender of the cop cruiser. I pulled into the parking lot and was maybe going 5mph.

Im incredibly embarrassed and I feel like an absolute d-bag. The cop seemed annoyed that he had to fill ojt a report for it toward the end of his shift, but did not seem upset and said it wasn't a big deal. The other officers on scene even said that since the damage was so minor that the town may not even bother to fix it. I called my supervisor right after and he didn't seem upset. I apologized and he didn't seem too bothered. Im not sure if he was just being nice.

I accepted 100% responsibility on scene and to my supervisor. I'm definitely not trying to make excuses at all, but the parking lot was not illuminated at all by any means. Whenever I drive or pull up somewhere I ALWAYS check both mirrors to check behind. Due to it being dark out and there being 0 elimination, I could not see anything from my mirrors. It's not an excuse by any means, but it didn't help the situation.

I just feel super embarassed and I feel awful that I scratched up another town's cruiser. I feel like Im the only one that has caused a fender bender. To make matters worse, I just accepted a FT position w my agency a week ago.

A friend is having a baby soon, and I want to put together a kit of life-saving (and maybe some nice to have) items for an infant. I'm a guy so my wife is handling the normal baby clothes and diaper gifts, which isn't my thing. I know a normal CAT7 is good for most children and a pressure bandage works for anything smaller, but I wanted to get some opinions. I am a Tactical Casualty Care instructor but he is untrained. If there is something that still works but is more simple to use / I can quickly train him (and his wife) on, that would be better.

I know there are some pediatric TQs and although they may be unnecessary, if they are more simple to use that's what matters (I don't expect them to be trainging regularly). I don't have kids, so any other small things like maybe ointments and basic meds are great recommendations. Thank you!

I've been wondering why more EMTs don't use their certification to get into other healthcare positions instead of just working just on the ambulance.

You can work as an ER tech or patient care tech. There are also positions like hyperbaric tech and telemetry tech that accepts EMTs.

If you get your AEMT you could have even more options. I've seen some places hire AEMTs for cath lab positions and some will even accept them for medical assistant roles.

I feel like a lot of people don't realize how many jobs they can apply for with an EMT certification.

I'm curious why more EMTs don't consider those. Is it because people prefer working on an ambulance or is it harder to get hired for these positions than I'm thinking?

I was at physical therapy a few days ago and for some odd reason I stood up from a machine and apparently fainted. I was able to go lie down and was working up my energy to make it to the front door.

Instead they called the 911 and before I knew it, the paramedics were there. I explained i didn’t want to go to the hospital and I just needed some time. Evidently I didn’t know the answer to some of their questions and my blood pressure was 180/110. I still didn’t want to go. I guess I was pretty insistent on not going and they were insistent on me going. We had a major difference in opinions. And I had a nasty headache. One of the paramedics and made a deal that if I could stand up without passing out, I could drive home.

Well, I stood up but i didn’t get to drive home.

I did not call them names and I did not hurl words at them but I wasn’t exactly friendly either. I just feel like shit for not being nice. One of the paramedics told the nurse “good luck with this one” as he walked out.

FTR- I was apparently there b/c risk of stroke or brain issue. I’ve previously been both concussed and had PRES this summer - both those times being transported by EMS. (One in July and one in August).

Was I viewed as a “hostile” patient? I didn’t yell or scream. Thanks.

I am seeking any and all information yall may have about organizations/resources that directly assist and support first responders who are experiencing a financial/housing emergency.

In order to keep this as concise as possible, I’m going to just state what is pertinent. I am able to expand on whatever needs to be expanded on in the comments or messages.

I am in the midst of a financial crisis which has now caused me to become homeless as of like right now. Due to an unexpected financial loss, I’m unable no longer able to afford staying where I have been staying. I have tried utilizing different subs, made for those experiencing financial hardship to request assistance from other members with no luck. I’ve researched and contacted every potential resource I can with no luck either. I don’t have any family members or friends who I can reach out to for support either for a multitude of reasons.

Will preface that I haven’t been on a rig in a considerable amount of time due to me stepping away to seek treatment and support because of my mental health and addiction issues. It is no secret that there is a dark, unseen side of this profession that is riddled with mental health problems and addiction. While it’s slowly but surely becoming more and more acceptable to talk about and awareness is being brought to it, there’s obviously still a stigma around it. Which is understandable.m

With all that being said, I appreciate your time and any input received.

What exercises or weight training do you perform so when doing CPR you can do it w/o hurting yourself and so you can do it longer.

I’ve been a medic for about 3 years, ran a code recently on an unknown etiology, but dude was still warm and pink. Code ran fine until we got ROSC, then the medic I was with said he didn’t like the igel because it kept slightly dislodging and wanted an ET. This guy has been a medic forever and was a flight medic so I trusted his judgement. He replaced the igel with an ET and we lost capnography, no waveform, no digital output. He confirmed visually that the tube was through the vocal cords with an airtraq, good lung sounds, negative gastric sounds, all the stuff, just no capno. We then lost pulses about 3 minutes after getting him back. We troubleshot the tube, then the inline capno, then the monitor, but I didn’t think to think the tube might just be bad until like 20 minutes into the code and lack of capno. We then switched back to the igel and capno returned.

There’s a lot more to the code, some other choices I didn’t make at the right time, or in the right way, but that one was the most significant. I own that I was leading the code, I should’ve made the switch back to the igel faster, but In struggling with the fact that I feel like I shouldn’t have made a mistake like this.

Other medics are telling me that these things happen, but man I feel like such a shit clinician.

i was transported by ambulance in nyc three weeks ago by and i literally cannot figure out any information. i have been calling the ambulance billing department every day and they searched the database by name , dob, time, date , and everything and they cannot find me. i just requested medical records to see if the hospital i arrived at can provide me w the ambulance information when i arrived. i have no idea what to do but i assume they went through my id because the hospital had my full name and home address. so it might just arrive at my house.

anyone have advice if they went thru something similar 😭 it feels like my transport went through a void lol